Evaluation of vertebral fractures on lateral chest radiographs of inner-city postmenopausal women.

We assessed the prevalence of vertebral fractures as a marker for osteoporosis on lateral chest radiographs in inner-city, minority, postmenopausal women. We reviewed outpatient lateral chest radiographs on all women 55 years and older at an inner-city hospital during two randomly selected months, August 2000 and April 2002. There were 106 women with a mean age of 65 (range 55-89) years, 45 were Hispanic, 42 Black, 9 White, 10 of other ethnicity. Deformity was graded on a 0-3 scale with Grades 2 (moderate) and 3 (severe) deformities considered fractures. Interval lateral chest radiographs within 1-2 years were evaluated. Of the group 25% (26/106) had vertebral fractures. The fracture prevalence increased with age: 13% (17/54) of women under 65 years and 37% (19/52) of women 65 years and older had fractures ( P < 0.05). The fracture was described as part of the radiographic report in only 15% (4/26) of the women. Of the group 15% (16/106) had interval lateral chest radiographs. Among those with interval lateral chest radiographs, 19% (3/16) developed new fractures. In this series 29% (31/106) of women were scheduled for bone density studies, but the studies were only completed in 6% (6/106). Lateral chest radiographs showed that vertebral fractures occurred commonly, increased with age, and progressed on follow-up. In a population of underserved minority women, the lateral chest radiograph provides an opportunity to identify women with osteoporosis for possible treatment.

Chest wall configuration assessed at total lung capacity during acute asthma and after recovery.

During acute asthma reversible increase in lung compliance and total lung capacity (TLC) have been observed. The magnitude of the increase in TLC, however, was found to be relatively small when TLC was measured radiographically. We wondered if structural distortion of the respiratory bellows develops during acute asthma attacks, accounting for the limited increase in TLC. We analyzed the chest wall dimensions using chest roentgenograms obtained in 32 patients who had previously participated in the study of radiographic evaluation of TLC. We found that the dimensional changes accompanying the small increase in TLC during acute asthma were nonuniform, consisting of mainly an increase in lung height (0.45 +/- 0.15 cm) with limited coordinated expansion of other dimensions and a small but significant distortional contraction of lung width at the lowest portion of the rib cage (-0.25 +/- 0.12 cm). These findings were interpreted to mean that in response to the decrease in elastic lung recoil (internal load) occurring during acute asthma, the diaphragm makes limited but effective further caudad descent without provoking serious structural distortion and that rib cage muscles, working at mechanical disadvantage at high lung volume, act largely as fixators.

Radiographic measurement of total lung capacity in acute asthma.

The thoracic cage appears to be large during attacks of asthma. Lung volume measurements by body plethysmography and helium dilution have suggested that total lung capacity may be increased during an acute attack of asthma, but doubt has been cast on the accuracy of these measurements in the presence of airflow obstruction. The change in total lung capacity has therefore been investigated during and after an acute attack of severe asthma in 32 patients by a radiographic technique. There was a small decrease (0.29 l) in mean total lung capacity between admission and follow up, though a quarter of the subjects showed a slight increase. There was no correlation between change in total lung capacity and change in expiratory flow rates, arterial carbon dioxide tension on admission, body mass index, and length of stay in hospital. Our findings agree with previous reports of a decrease in total lung capacity with improving airway obstruction, but the changes were small and inconsistent.

A simple approach to the diagnosis of bronchopleural fistula.

The authors describe a simple, yet reliable technique for confirmation of a bronchopleural fistula. It is based on detection of radioactivity in the pleural space after the washout phase of the 133Xe ventilation study. This method demonstrated the pathological communication while bronchoscopy, bronchography, and methylene blue testing did not.

The target sign: a new radiologic sign of septic pulmonary emboli.

A new radiographic sign consisting of a pulmonary density suspended in a thin-walled cystic area is described in five patients with hematogenously disseminated infection. A pathogenetic mechanism is suggested to account for this "target sign." The relationship of these findings to pulmonary pneumatoceles is also discussed.