Errores en la interpretación de la radiografía de tórax en el lactante: ¿qué tenemos que saber de la técnica? / Errors in the Interpretation of chest X-rays in Infants: what do we need to know about the technique?

La radiografía de tórax sigue siendo fundamental para la evaluación de patologías torácicas en lactantes. Antes de iniciar su interpretación, muchos autores sugieren revisar la técnica radiológica, ya que a esta edad se presentan varias particularidades técnicas que deben tenerse en cuenta para evitar errores interpretativos y no confundir hallazgos técnicos con patologías. Entre estas particularidades técnicas se deben evaluar: el centraje transversal o rotación, el centraje longitudinal o posición lordótica, el grado de inspiración, la posición de la vía aérea superior, la penetración o exposición de la radiografía, tipos de proyecciones y el movimiento. El objetivo de esta revisión es comentar y ejemplificar las peculiaridades técnicas que presenta la radiografía de tórax en lactantes y que pueden llevar a interpretaciones erróneas.

The chest X-ray remains essential for evaluating thoracic pathology in infants. Before beginning its interpretation, many authors recommend assessing the radiographic technique, as several technical peculiarities must be considered at this age to avoid interpretive errors and prevent mistaking technical artifacts for pathology. The technical aspects to be evaluated include transverse centering or rotation, longitudinal centering or lordotic position, degree of inspiration, upper airway positioning, radiograph penetration or exposure, projection types, and movement. The objective of this review is to discuss and illustrate the technical peculiarities of infant chest X-rays that can lead to erroneous interpretations.

Patient-centered Radiology: Overview and Opportunities in Cardiothoracic Imaging.

Radiology is unique compared with most other medical specialties in that care can sometimes be delivered without speaking to or touching the patient. Although radiologists have increasingly become involved in patient safety, quality improvement, informatics, and advocacy, they must still work harder than other medical specialties to be considered "patient-facing." While cardiothoracic radiologists have likely experienced fewer opportunities to directly interface with patients, shared decision-making with patients around lung cancer screening and radiation dose optimization are both excellent examples of patient-centered and family-centered care in cardiothoracic imaging. Many cardiothoracic examinations necessitate medication administration or customized breath-holds not required of other examinations and create an opportunity for discussion between cardiothoracic radiologists and patients. Opportunities to increase the patient-centered focus in radiology exist at every interface between the radiology practice and the patient. Implementing the principles of patient-centered and family-centered care in a radiology department or practice requires the participation and engagement of all stakeholders, including patients.

Thoracic calcifications on magnetic resonance imaging: correlations with computed tomography.

OBJECTIVE: To identify the characteristics of thoracic calcifications on magnetic resonance (MR) imaging, as well as correlations between MR imaging and CT findings. METHODS: This was a retrospective study including data on 62 patients undergoing CT scans and MR imaging of the chest at any of seven hospitals in the Brazilian states of Rio Grande do Sul, São Paulo, and Rio de Janeiro between March of 2014 and June of 2016 and presenting with calcifications on CT scans. T1- and T2-weighted MR images (T1- and T2-WIs) were semiquantitatively analyzed, and the lesion-to-muscle signal intensity ratio (LMSIR) was estimated. Differences between neoplastic and non-neoplastic lesions were analyzed. RESULTS: Eighty-four calcified lesions were analyzed. Mean lesion density on CT was 367 ± 435 HU. Median LMSIRs on T1- and T2-WIs were 0.4 (interquartile range [IQR], 0.1-0.7) and 0.2 (IQR, 0.0-0.7), respectively. Most of the lesions were hypointense on T1- and T2-WIs (n = 52 [61.9%] and n = 39 [46.4%], respectively). In addition, 19 (22.6%) were undetectable on T1-WIs (LMSIR = 0) and 36 (42.9%) were undetectable on T2-WIs (LMSIR = 0). Finally, 15.5% were hyperintense on T1-WIs and 9.5% were hyperintense on T2-WIs. Median LMSIR was significantly higher for neoplastic lesions than for non-neoplastic lesions. There was a very weak and statistically insignificant negative correlation between lesion density on CT and the following variables: signal intensity on T1-WIs, LMSIR on T1-WIs, and signal intensity on T2-WIs (r = -0.13, p = 0.24; r = -0.18, p = 0.10; and r = -0.16, p = 0.16, respectively). Lesion density on CT was weakly but significantly correlated with LMSIR on T2-WIs (r = -0.29, p < 0.05). CONCLUSIONS: Thoracic calcifications have variable signal intensity on T1- and T2-weighted MR images, sometimes appearing hyperintense. Lesion density on CT appears to correlate negatively with lesion signal intensity on MR images.

Thoracic calcifications on magnetic resonance imaging: correlations with computed tomography / Calcificações torácicas na ressonância magnética: correlações com a tomografia computadorizada

ABSTRACT Objective: To identify the characteristics of thoracic calcifications on magnetic resonance (MR) imaging, as well as correlations between MR imaging and CT findings. Methods: This was a retrospective study including data on 62 patients undergoing CT scans and MR imaging of the chest at any of seven hospitals in the Brazilian states of Rio Grande do Sul, São Paulo, and Rio de Janeiro between March of 2014 and June of 2016 and presenting with calcifications on CT scans. T1- and T2-weighted MR images (T1- and T2-WIs) were semiquantitatively analyzed, and the lesion-to-muscle signal intensity ratio (LMSIR) was estimated. Differences between neoplastic and non-neoplastic lesions were analyzed. Results: Eighty-four calcified lesions were analyzed. Mean lesion density on CT was 367 ± 435 HU. Median LMSIRs on T1- and T2-WIs were 0.4 (interquartile range [IQR], 0.1-0.7) and 0.2 (IQR, 0.0-0.7), respectively. Most of the lesions were hypointense on T1- and T2-WIs (n = 52 [61.9%] and n = 39 [46.4%], respectively). In addition, 19 (22.6%) were undetectable on T1-WIs (LMSIR = 0) and 36 (42.9%) were undetectable on T2-WIs (LMSIR = 0). Finally, 15.5% were hyperintense on T1-WIs and 9.5% were hyperintense on T2-WIs. Median LMSIR was significantly higher for neoplastic lesions than for non-neoplastic lesions. There was a very weak and statistically insignificant negative correlation between lesion density on CT and the following variables: signal intensity on T1-WIs, LMSIR on T1-WIs, and signal intensity on T2-WIs (r = −0.13, p = 0.24; r = −0.18, p = 0.10; and r = −0.16, p = 0.16, respectively). Lesion density on CT was weakly but significantly correlated with LMSIR on T2-WIs (r = −0.29, p < 0.05). Conclusions: Thoracic calcifications have variable signal intensity on T1- and T2-weighted MR images, sometimes appearing hyperintense. Lesion density on CT appears to correlate negatively with lesion signal intensity on MR images.

RESUMO Objetivo: Identificar as características das calcificações torácicas na ressonância magnética (RM) e as correlações entre os achados de RM e TC. Métodos: Estudo retrospectivo no qual foram analisados dados referentes a 62 pacientes que foram submetidos a TC e RM de tórax em sete hospitais nos estados do Rio Grande do Sul, São Paulo e Rio de Janeiro entre março de 2014 e junho de 2016 e que apresentaram calcificações na TC. As imagens de RM ponderadas em T1 e T2 (doravante denominadas T1 e T2) foram analisadas semiquantitativamente, e a razão entre a intensidade do sinal da lesão e do músculo (LMSIR, do inglês lesion-to-muscle signal intensity ratio) foi estimada. Diferenças entre lesões neoplásicas e não neoplásicas foram analisadas. Resultados: Foram analisadas 84 lesões calcificadas. A média de densidade das lesões na TC foi de 367 ± 435 UH. A mediana da LMSIR foi de 0,4 [intervalo interquartil (II): 0,1-0,7] em T1 e 0,2 (II: 0,0-0,7) em T2. A maioria das lesões mostrou-se hipointensa em T1 e T2 [n = 52 (61,9%) e n = 39 (46,4%), respectivamente]. Além disso, 19 (22,6%) foram indetectáveis em T1 (LMSIR = 0) e 36 (42,9%) foram indetectáveis em T2 (LMSIR = 0). Finalmente, 15,5% mostraram-se hiperintensas em T1 e 9,5% mostraram-se hiperintensas em T2. A mediana da LMSIR foi significativamente maior nas lesões neoplásicas do que nas não neoplásicas. Houve uma correlação negativa muito fraca e estatisticamente insignificante entre a densidade das lesões na TC e as seguintes variáveis: intensidade do sinal em T1, LMSIR em T1 e intensidade do sinal em T2 (r = −0,13, p = 0,24; r = −0,18, p = 0,10 e r = −0,16, p = 0,16, respectivamente). A densidade das lesões na TC apresentou correlação fraca, porém significativa com a LMSIR em T2 (r = −0,29, p < 0,05). Conclusões: As calcificações torácicas apresentam intensidade de sinal variável em T1 e T2; em alguns casos, mostram-se hiperintensas. A densidade da lesão na TC aparentemente correlaciona-se negativamente com a intensidade do sinal da lesão na RM.

Acurácia do protocolo blue em relação à radiografia torácica em cães / Accuracy of blue protocol in relation to thoracic radiography in dogs / Precisión del protocolo azul en relación con la radiografía torácica en los perros

A abordagem do paciente crítico deve ser realizada de forma rápida e dinâmica, tendo profissionais preparados e capacitados para agirem de maneira precisa e ágil. Distrição respiratória é uma das mais comuns manifestações clínicas neste nicho de pacientes, possuindo, uma ampla gama de diferenciais. A radiografia torácica nestas situações torna-se inviável, por colocar o paciente em risco, até mesmo pelo simples posicionamento radiográfico. O protocolo do exame ultrassonográfico pulmonar ao leito, em inglês "Bedside Lung Ultrasound Exam (BLUE)" utilizado na medicina, e trazido para a medicina veterinária sob o nome de "VetBLUE", consta de uma análise ultrassonográfica do tórax, através de artefatos que interferem no padrão de reverberação normal do pulmão, como por exemplo as caudas de cometa, também chamadas linhas B, linhas verticais hiperecogênicas, que partem da linha pleural e apagam o padrão de reverberação pulmonar, elas são indicativas da presença de líquido no interstício pulmonar. O trabalho em questão utilizou 30 animais de forma randômica da rotina do Hovet-FMU, sendo primeiramente realizado a avaliação com o protocolo "BLUE" seguido do exame radiográfico, os resultados foram então analisados de duas formas: um teste não probabilístico Kappa das janelas do protocolo em comparação à radiografia e uma correlação dos achados de maneira mais simples, para verificar se o mesmo é tão eficiente quanto a radiografia para a visualização de alterações.(AU)

The critical patient approach should be performed quickly and dynamically, with trained and skilled professionals to act in a precise and agile manner. Respiratory distress is one of the most common clinical manifestations in this niche of patients, possessing a wide range of differentials. The chest radiography in these situations becomes impractical, because it puts the patient at risk, even by the simple radiographic positioning. The "Bedside Lung Ultrasound Examination Protocol (BLUE)" used in medicine, and brought to veterinary medicine under the name "VetBLUE", consists of a sonographic analysis of the thorax through Artifacts that interfere with the normal reverberation pattern of the lung, such as comet tails, also called B-lines, hyperechogenic vertical lines, which depart from the pleuralline and extinguish the pulmonary reverberation pattern, they are indicative of the presence offluid in the lung interstitium. The study used 30 animais randomly from the Hovet-FMU routine, and the evaluation was first performed with the BLUE protocol followed by the radiographic examination, the results were then analyzed in two ways: a non-probabilistic Kappa test of the windows Protocol in comparison to radiography and a correlation of the findings in a simpler way to verify if it is as efficient as the radiography for the visualization of changes. The results obtained demonstrated a sensitivity of 75%, a specificity of 85% and an accuracy of 80% in the perception of alterations in the pulmonary parenchyma of animais in several stages 01 evolution, from the incipient ones to the severely affected, in spite ofthe values obtained, the pulmonary ultrasound evaluation With the BLUE protocol should be limited to emergency patients, where most of the affections reach the thoracic periphery, thus allowing their visualization, and an adequate radiographic or tomographic evaluation is not possible.(AU)

El enfoque del paciente crítico debe ser realizado de forma rápida y dinámica, teniendo profesionales preparados y capacitados para actuar de manera precisa y ágil. La districión respiratoria es una de las más comunes manifestaciones clínicas en este nicho de pacientes, con una amplia gama de diferenciales. La radiografía torácica en estas situaciones se vuelve inviable, por colocar ai paciente en riesgo, incluso por el simple posicionamiento radiográfico. El protocolo del examen ultrasonográfico pulmonar ai lecho, en inglés "bedside pulmonar ultrasound exam" ("BLUE") utilizado en la medicina, y traído a la medicina veterinaria con el nombre de "VetBLUE", consta en un análisis ultrasonográfico del tórax, a través de los artefactos que interfieren en el patrón de reverberación normal del pulmón, como por ejemplo las colas de cometa, también llamadas líneas B, líneas verticales hiperecogénicas, que parten de la línea pleural y apagan el patrón de reverberación pulmonar, ellas son indicativas de la presencia de líquido en el intersticio pulmón. El trabajo en cuestión utilizá 30 animales de forma aleatoria de la rutina del Hovet-FMU, siendo primero realizada la evaluación con el protocolo "BLUE" seguido del examen radiográfico, los resultados fueron entonces analizados de dos formas: una prueba no probabilística Kappa de las ventanas del protocolo en comparación con la radiografía y una correlación de los hallazgos de manera más simple, para verificar si el mismo es tan eficiente como la radiografía para la visualización de cambios.(AU)

Acurácia do protocolo blue em relação à radiografia torácica em cães / Accuracy of blue protocol in relation to thoracic radiography in dogs / Precisión del protocolo azul en relación con la radiografía torácica en los perros

A abordagem do paciente crítico deve ser realizada de forma rápida e dinâmica, tendo profissionais preparados e capacitados para agirem de maneira precisa e ágil. Distrição respiratória é uma das mais comuns manifestações clínicas neste nicho de pacientes, possuindo, uma ampla gama de diferenciais. A radiografia torácica nestas situações torna-se inviável, por colocar o paciente em risco, até mesmo pelo simples posicionamento radiográfico. O protocolo do exame ultrassonográfico pulmonar ao leito, em inglês "Bedside Lung Ultrasound Exam (BLUE)" utilizado na medicina, e trazido para a medicina veterinária sob o nome de "VetBLUE", consta de uma análise ultrassonográfica do tórax, através de artefatos que interferem no padrão de reverberação normal do pulmão, como por exemplo as caudas de cometa, também chamadas linhas B, linhas verticais hiperecogênicas, que partem da linha pleural e apagam o padrão de reverberação pulmonar, elas são indicativas da presença de líquido no interstício pulmonar. O trabalho em questão utilizou 30 animais de forma randômica da rotina do Hovet-FMU, sendo primeiramente realizado a avaliação com o protocolo "BLUE" seguido do exame radiográfico, os resultados foram então analisados de duas formas: um teste não probabilístico Kappa das janelas do protocolo em comparação à radiografia e uma correlação dos achados de maneira mais simples, para verificar se o mesmo é tão eficiente quanto a radiografia para a visualização de alterações.

The critical patient approach should be performed quickly and dynamically, with trained and skilled professionals to act in a precise and agile manner. Respiratory distress is one of the most common clinical manifestations in this niche of patients, possessing a wide range of differentials. The chest radiography in these situations becomes impractical, because it puts the patient at risk, even by the simple radiographic positioning. The "Bedside Lung Ultrasound Examination Protocol (BLUE)" used in medicine, and brought to veterinary medicine under the name "VetBLUE", consists of a sonographic analysis of the thorax through Artifacts that interfere with the normal reverberation pattern of the lung, such as comet tails, also called B-lines, hyperechogenic vertical lines, which depart from the pleuralline and extinguish the pulmonary reverberation pattern, they are indicative of the presence offluid in the lung interstitium. The study used 30 animais randomly from the Hovet-FMU routine, and the evaluation was first performed with the BLUE protocol followed by the radiographic examination, the results were then analyzed in two ways: a non-probabilistic Kappa test of the windows Protocol in comparison to radiography and a correlation of the findings in a simpler way to verify if it is as efficient as the radiography for the visualization of changes. The results obtained demonstrated a sensitivity of 75%, a specificity of 85% and an accuracy of 80% in the perception of alterations in the pulmonary parenchyma of animais in several stages 01 evolution, from the incipient ones to the severely affected, in spite ofthe values obtained, the pulmonary ultrasound evaluation With the BLUE protocol should be limited to emergency patients, where most of the affections reach the thoracic periphery, thus allowing their visualization, and an adequate radiographic or tomographic evaluation is not possible.

El enfoque del paciente crítico debe ser realizado de forma rápida y dinámica, teniendo profesionales preparados y capacitados para actuar de manera precisa y ágil. La districión respiratoria es una de las más comunes manifestaciones clínicas en este nicho de pacientes, con una amplia gama de diferenciales. La radiografía torácica en estas situaciones se vuelve inviable, por colocar ai paciente en riesgo, incluso por el simple posicionamiento radiográfico. El protocolo del examen ultrasonográfico pulmonar ai lecho, en inglés "bedside pulmonar ultrasound exam" ("BLUE") utilizado en la medicina, y traído a la medicina veterinaria con el nombre de "VetBLUE", consta en un análisis ultrasonográfico del tórax, a través de los artefactos que interfieren en el patrón de reverberación normal del pulmón, como por ejemplo las colas de cometa, también llamadas líneas B, líneas verticales hiperecogénicas, que parten de la línea pleural y apagan el patrón de reverberación pulmonar, ellas son indicativas de la presencia de líquido en el intersticio pulmón. El trabajo en cuestión utilizá 30 animales de forma aleatoria de la rutina del Hovet-FMU, siendo primero realizada la evaluación con el protocolo "BLUE" seguido del examen radiográfico, los resultados fueron entonces analizados de dos formas: una prueba no probabilística Kappa de las ventanas del protocolo en comparación con la radiografía y una correlación de los hallazgos de manera más simple, para verificar si el mismo es tan eficiente como la radiografía para la visualización de cambios.

Endometriosis diafragmática: a propósito de un caso / Diaphragmatic endometriosis: about a case

ANTECEDENTES: La endometriosis afecta entre 5 al 15% de las mujeres en edad reproductiva. La presentación torácica es una entidad de baja frecuencia (menos del 1% de todos los casos de endometriosis), y puede localizarse en vía aérea, parénquima, pleuras o diafragma. Sus manifestaciones clínicas habitualmente se presentan dentro de las primeras 72 horas del inicio de la menstruación y consisten en dolor torácico, neumotórax o hemoptisis. El mejor manejo consiste en supresión hormonal y manejo quirúrgico en casos refractarios. OBJETIVOS: Describir un caso de endometriosis diafragmática tratada satisfactoriamente por videotoracoscopia. CASO CLÍNICO: Mujer de 27 años, con antecedentes de endometriosis ovárica operada con electrofulguración dos años previo. Consulta por omalgia derecha y dado antecedentes de endometriosis pélvica, se solicita TAC torácico, que informa formación sólida, ovoídea, de 30 mm x 13 mm, que capta contraste en forma parcial ubicado en la región subdifragmática derecha. Se interpreta imagen como posible foco de endometriosis, se complementa con RNM que es concordante con el diagnóstico. Se realiza videotoracoscopia derecha con resección diafragmática y reparación primaria. Anatomía patológica informa focos de endometriosis con márgenes negativos. Se retira la pleurostomía a las 48 horas, siendo dada de alta a los tres días. A un año de seguimiento, está asintomatica y sin evidencia de recidiva. CONCLUSIÓN: A pesar de su baja frecuencia, la endometriosis torácica representa un importante compromiso de la calidad de vida. Casos con complicaciones torácicas, con regular o deficiente respuesta a terapia hormonal, se benefician de resolución quirúrgica por vía mínimamente invasiva.

BACKGROUND: Endometriosis affects between 5 to 15% of women of reproductive age. Thoracic presentation entity is infrequent (less than 1% of all cases of endometriosis) and may be located in airway parenchyma, pleura or diaphragm. Its clinical manifestations usually occur within the first 72 hours of onset of menstruation and include chest pain, pneumothorax or hemoptysis. Better management consists of hormonal suppression and surgical management in refractory cases. OBJECTIVE: To describe a case of diaphragmatic endometriosis, successfully treated by video-assisted thoracoscopic surgery (VATS). CASE REPORT: Woman of 27 years old, with a history of ovarian endometriosis operated by electrofulguration two years before. She present right omalgia and a history of pelvic endometriosis. Chest CT report a solid, ovoid formation, 30 mm x 13 mm, which captures contrast partially, located in the right sub diaphragmatic region. Image is interpreted as a possible focus of endometriosis, it is complemented by RNM that is consistent with the diagnosis. It is performed VATS right with diaphragmatic resection and primary repair. Pathology reports endometriosis with negative margins. The pleurostomy is removed after 48 hours, she was discharged after three days. A one year follow up, it is asymptomatic and without evidence of recurrence. CONCLUSION: Despite its low frequency, the thoracic endometriosis represents an important commitment to the quality of life. Cases with chest complications, and with fair or poor response to hormone therapy, benefit with minimally invasive surgical resolution.

Thoracic manifestations of collagen vascular diseases.

Collagen vascular diseases are a diverse group of immunologically mediated systemic disorders that often lead to thoracic changes. The collagen vascular diseases that most commonly involve the lung are rheumatoid arthritis, progressive systemic sclerosis, systemic lupus erythematosus, polymyositis and dermatomyositis, mixed connective tissue disease, and Sjögren syndrome. Interstitial lung disease and pulmonary arterial hypertension are the main causes of mortality and morbidity among patients with collagen vascular diseases. Given the broad spectrum of possible thoracic manifestations and the varying frequency with which different interstitial lung diseases occur, the interpretation of thoracic images obtained in patients with collagen vascular diseases can be challenging. The task may be more difficult in the presence of treatment-related complications such as drug toxicity and infections, which are common in this group of patients. Although chest radiography is most often used for screening and monitoring of thoracic alterations, high-resolution computed tomography can provide additional information about lung involvement in collagen vascular diseases and may be especially helpful for differentiating specific disease patterns in the lung. General knowledge about the manifestations of thoracic involvement in collagen vascular diseases allows radiologists to provide better guidance for treatment and follow-up of these patients.

Congenital thoracic vascular anomalies.

Congenital vascular anomalies of the thorax represent an important group of entities that can occur either in isolation or in association with different forms of congenital heart disease. It is extremely important that radiologists have a clear understanding of these entities, their imaging characteristics, and their clinical relevance. The imaging armamentarium available to diagnose these diverse conditions is ample, and has evolved from such traditional methods as chest radiography, barium esophagography, and angiography to new modalities that include echocardiography, multidetector row CT (MDCT), and MR imaging. These imaging modalities have added safety, speed, and superb resolution in diagnosis and, as in the case of MDCT, provide additional information about the airway and lung parenchyma, resulting in a more comprehensive examination with greater anatomic coverage. This article reviews the most important congenital thoracic vascular anomalies, their embryologic foundation, clinical presentation, and imaging characteristics, especially those of MDCT.

Recent advances in sonographic imaging of fetal thoracic structures.

Recent ultrasonographic methods applied in the evaluation of fetal thoracic structures and anomalies are presented. Fetal lung volumetric assessment by 3D ultrasonography, analysis of the thoracic wall by 3D-rendered image and 3D skeletal-mode imaging, intrathoracic vessel evaluation by 3D power Doppler ultrasonography, analysis of heart anatomy and abnormalities by 4D spatiotemporal image correlation, identification of normal and abnormal intrathoracic almost isoechogenic structures by volume contrast imaging and evaluation of the heart and great vessels by 3 and 4D inverse mode will be reviewed.

[X-ray computed tomographic and radiographic aspects of thoracic actinomycosis]. / Aspects radiographiques et tomodensitométriques de l'actinomycose thoracique.

UNLABELLED: The aim of this study was to evaluate chest radiographs and computed tomography (CT) in patients with thoracic actinomycosis. MATERIAL AND METHOD: Chest radiographs and CT scans of 9 patients with proved thoracic actinomycosis were reviewed. CT scans were performed after intravenous contrast administration. RESULTS: Airspace consolidation was present in the upper lobes in 6 patients and in the lower lobes in 3. Cavitations not apparent on the radiographs were seen on CT s in 2 cases. Mediastinal lymphadenopathies were seen on CT s in 2 cases, in one the infection extended through the mediastinal pleura into the mediastinum. Pleural thickening adjacent to the airspace consolidation was identified in 6 cases. Chest wall invasion occurred in 4 cases with a wavy periostal reaction involving ribs adjacent to the site of parenchymal involvement in 3 cases. Extension into the abdomen through the diaphragm was seen in one case. DISCUSSION: In humans, actinomycosis involves the thorax in 15% of the cases. Thoracic and pulmonary parenchymal involvement is usually secondary to aspiration of colonized material from the oropharynx in patients with poor oral hygiene. There is a basilar predominance of the disease, but some studies have reported apical predominance. The pulmonary infection leads to an airspace consolidation mainly in the lung periphery. The infection may extend across fissures and through the pleura. Chest wall and bone invasion are not uncommon. A wavy periosteal reaction involving ribs is said to be highly suggestive of pulmonary actinomycosis. CONCLUSION: Thoracic actinomycosis is characterized by airspace consolidation with adjacent pleural thickening. Chest wall invasion with a wavy periosteal reaction is highly suggestive.

[The use of thoracic radiography in a third-level-care pediatric hospital]. / Utilización de la radiografía de tórax en un hospital pediátrico de tercer nivel de atención.

OBJECTIVES: 1. To describe the frequency in which the thorax radiography is requested in a third-level pediatric hospital, 2. To identify the frequency of detected abnormalities in such a study by the radiology service, 3. To describe the frequency and the characteristics form the information considered as useful in a clinical way, not only in the radiography application but in the radiologic report and the clinical file as well, 4. To identify the frequency in which the thorax radiography result is associated with diagnosis changes and/or therapeutic ones. DESIGN OF THE INVESTIGATION: Descriptive survey. STUDY UNITS: 371 thorax X-rays completed during December 1990 and January 1991. PRIMARY RESULTS: The thorax radiographies were 32% of the entire radiological study during the survey; 335 of the latter ones (90%) were requested for inpatients. The hospital services which had the highest request for such a study were the Intensive Care Unit (n = 149, 40%) and Medical Pediatrics (n = 116, 31%). The most frequent diagnosis leading to the application was pneumonia (n = 55, 15%) and solid neoplasia (n = 51, 14%). Three-hundred forty eight of the applications had diagnostic impression given by the physician in charge(94%); whereas only 127 (34%) mentioned clinical data. The radiology report was attached to the file in 162 (44%) of the cases. It was found that form the patients who had a radiology report and the thorax radiography as an initial study (n = 95), 48 (50%) suffered from abnormalities. The results of the study were transcribed in the file in 58 cases (16%); the physician's interpretation was written down in 229 cases (62%) and in 84 studies (23%) there was no reference to the results of the study (P < 0.0001). Changes in the therapeutic plan of 93 cases (50%) were identified from the studies with official report by the radiologist, other radiology studies were requested in 65 of the patients (35%), after the interpretation of such study. CONCLUSIONS: Abnormalities in 50% were identified from the total thorax radiographies requested as the patient entered. The study application mentioned as a whole (94%) the diagnostic impression which led to the application, but only in 127 cases (34%) were supporting clinical data written down. The radiology report was attached to the file in less than half the cases (44%). In 63% of the cases the supporting reason of the study was written down whereas in 23% there was no reference to the result at all.

Thoracic complications of extracorporeal membrane oxygenation: findings on chest radiographs and sonograms.

Neonates treated with extracorporeal membrane oxygenation (ECMO) for respiratory failure have a high frequency of complications related to systemic anticoagulation, ECMO and other life-support lines and catheters, and the antecedent pulmonary disease. Many of these complications involve the thorax and can be defined on chest radiographs or thoracic sonograms. The purpose of this essay is to illustrate the findings of the various thoracic complications of ECMO on chest radiographs and sonograms. This study is based on a review of the medical records and findings on chest radiographs and sonograms of 150 neonates who were treated with ECMO at our institution.