Evaluation Of Chest Radiographs Research Articles

Dynamic chest radiographic evaluation of the effects of tiotropium/olodaterol combination therapy in chronic obstructive pulmonary disease: the EMBODY study protocol for an open-label, prospective, single-centre, non-controlled, comparative study

IntroductionTo date, there is limited evidence on the effects of bronchodilators on respiratory dynamics in chronic obstructive pulmonary disease (COPD). Dynamic chest radiography (DCR) is a novel radiographic modality that...

Needle Aspiration in Tuberculosis-Associated Secondary Spontaneous Pneumothorax

Introduction: The management of tuberculosis-associated secondary spontaneous pneumothorax mostly requires chest tube insertion for complete drainage and resolution. We reported a case of tuberculosis-associated secondary spontaneous pneumothorax that improved with needle aspiration. Case: A 29-year-old female with pulmonary tuberculosis presented with sudden onset shortness of breath. Chest examination revealed asymmetry, decreased vocal fremitus, hypersonor, and decreased vesicular sound in the right lung field. Chest radiograph showed right pneumothorax with a 2 cm intrapleural distance. Needle aspiration was performed because the patient refused chest tube insertion. The first needle aspiration evacuated approximately 615 cc of air. The second needle aspiration was repeated 24 hours later due to clinical deterioration, and 610 cc of air was evacuated. Chest radiograph evaluation on the 6th day of treatment showed no pneumothorax. During hospitalization, the patient received oxygen therapy, anti-tuberculosis drugs, chest physiotherapy, and other symptomatic therapies such as mucolytics. The patient's condition improved, and she was discharged on the 9th day of hospitalization. Tuberculosis-associated secondary pneumothorax occurs in 1-3% of cases. Conclusion: Needle aspiration is a therapeutic modality for tuberculosis-associated secondary spontaneous pneumothorax. This modality has several advantages, including shorter length of stay, less cost and pain, and fewer complications. Needle aspiration combined with oxygen therapy, anti-tuberculosis drugs, and chest physiotherapy should be the modality of treatment for tuberculosis-associated secondary pneumothorax.

Evaluation of chest radiograph for image quality in a national hospital, Nepal

Evaluation of chest radiograph for image quality in a national hospital, Nepal

Radiological features of round pneumonia in children: 10 years of experience

Aim: Round pneumonia (RP) is a type of pneumonia that appears round on imaging studies and usually occurs in children. Although round pneumonia is a well-known clinical condition, few publications available in the literature describing the imaging findings and features of round pneumonia. The purpose of the review was to evaluate the chest radiographs, chest ultrasonography and CT findings associated findings of round pneumonia as compared to the published literature.
 Material and Method: 65 children who were diagnosed with round pneumonia in our hospital between December 2010 and July 2020 were included in our study. Initial chest radiographs and CT scans were evaluated for lesion parameters: number, margin, opacity, size, location, and hilar LAP and air bronchogram accompaniment. Follow-up chest radiographs were evaluated for temporal variation (resolution or progression to lobar pneumonia). The findings of the patients who underwent chest ultrasonography were recorded.
 Results: The mean age of the 65 children with round pneumonia included was 6.2 years and their ages ranged from 9 months to 16 years. Evaluation of chest radiographs showed one lesion in each of 63 children (96%, 63/65) and two lesions in two children (4%, 2/65). Lesion margins were sharp in 84% (55/65) and the mean diameter of lesions was 2,5 cm with a range of 1.5–9.5 cm. On the radiograph, the opacity of round pneumonia was low (60%, 39/65) and hilar lymphadenopathy was detected in 1 out of 5 patients (20%, 13/65). The location of the lesion tended to be posterior (51%, 33/65) and upper lobe (54%, 35/65). On chest ultrasonography, consalidation was seen in 8 patients, consalidation and pleural effusion were seen in 3 patients. CT images were available in 11 (17%) children. Pleural thickening or satellite lesions were not observed in any of the patients on tomography. Follow-up radiographs tended to show resolution in 95% (62/65) and progression to lobar pneumonia in 4.6% (3/65). 1 patient progressed to lobar pneumonia and died. 2 patients developed cavitary pneumonia.
 Conclusion: Round pneumonia is a benign type of pneumonia that is mostly seen in children due to its physiopathology. Most patients with RP recover clinically and radiologically after antibiotic therapy. Although there are many diseases in the differential diagnosis, knowing the radiological features facilitates the diagnosis and prevents unnecessary diagnostic and imaging studies.

Radiographic assessment of traction-induced esophageal growth and traction-related complications of the Foker process for treatment of long-gap esophageal atresia.

Radiographic assessment of esophageal growth in long-gap esophageal atresia while on traction and associated traction-related complications have not been described. To demonstrate how chest radiography can estimate esophageal position while on traction and to evaluate radiography's utility in diagnosing certain traction system complications. In this retrospective evaluation of portable chest radiographs obtained in infants with long-gap esophageal atresia who underwent the Foker process between 2014 and 2020, we assessed distances between the opposing trailing clips (esophageal gap) and the leading and trailing clips for each esophageal segment on serial radiographs. Growth during traction was estimated using longitudinal random-effects regression analysis to account for multiple chest radiograph measurements from the same child. Forty-three infants (25 male) had a median esophageal gap of 4.5cm. Median traction time was 14days. Median daily radiographic esophageal growth rate for both segments was 2.2mm and median cumulative growth was 23.6mm. Traction-related complications occurred in 13 (30%) children with median time of 8days from traction initiation. Daily change >12% in leading-to trailing clip distance demonstrated 86% sensitivity and 92% specificity for indicating traction-related complications (area under the curve [AUC] 0.853). Cumulative change >30% in leading- to trailing-clip distance during traction was 85% sensitive and 85% specific for indicating traction complications (AUC 0.874). Portable chest radiograph measurements can serve as a quantitative surrogate for esophageal segment position in long-gap esophageal atresia. An increase of >12% between two sequential chest radiographs or >30% increase over the traction period in leading- to trailing-clip distance is highly associated with traction system complications.

Limited Clinical Utility of Chest Radiography in Asymptomatic Patients after Interventional Radiology-Performed Ultrasound-Guided Thoracentesis: Analysis of 3,022 Consecutive Patients

Abstract Purpose The aim of this study was to report the utility of chest radiography following interventional radiology-performed ultrasound-guided thoracentesis. Materials and Methods A total of 3,998 patients underwent thoracentesis between 2003 and 2018 at two institutions. A total of 3,022 (75.6%) patients were older than 18 years old, underwent interventional radiology-performed ultrasound-guided thoracentesis, and had same-day post-procedure chest radiograph evaluation. Patient age (years), laterality of thoracentesis, procedural technical success, volume of fluid removed (mL), method of post-procedure chest imaging, absence or presence of pneumothorax, pneumothorax size (mm), pneumothorax management measures, and clinical outcomes were recorded. Technical success was defined as successful aspiration of pleural fluid. Post-procedure clinical outcomes included new patient-perceived dyspnea and hypoxia (oxygen saturations < 90% on room air). Costs associated with radiographs were estimated using Medicare and Medicaid fee schedules. Results Mean age was 56.7 ± 15.5 years. Interventional radiology-performed ultrasound-guided thoracentesis was performed on the left (n = 1,531; 50.7%), right (n = 1,477; 48.9%), and bilaterally (n = 14; 0.5%) using 5-French catheters. Technical success was 100% (n = 3,022). Mean volume of 940 ± 550 mL of fluid was removed. Post-procedure imaging was performed in the form of posteroanterior (PA) (2.6%; 78/3,022), anteroposterior (AP) (17.0%; 513/3,022), PA and lateral (77.9%; 2,355/3,022), or PA, lateral, and left lateral decubitus (2.5%; 76/3,022) chest radiographs. Post-procedural pneumothorax was identified in 21 (0.69%) patients. Mean pneumothorax size, measured on chest radiograph as the longest distance from the chest wall to the lung, was 18.8 ± 10.2 mm (range: 5.0–35.0 mm). Of the 21 pneumothoraces, 7 (33.3%) were asymptomatic, resolved spontaneously, and had a mean size of 6.4 ± 2.4 mm. Fourteen pneumothoraces, of mean size 25.0 ± 5.8 mm, required management with a pleural drainage catheter (66.6%). The overall incidence of pneumothorax requiring pleural drainage catheter placement following interventional radiology-performed ultrasound-guided thoracentesis was 0.46% (14/3,022). Of the patients requiring drainage catheter placement, 12/14 (85.7%) and 13/14 (92.9%) had dyspnea and hypoxia, respectively. Potential costs to Medicare and Medicaid, for chest radiographs, in this study, were $27,547 and $10,581, respectively. Conclusion The incidence of clinically significant pneumothorax requiring catheter drainage following interventional radiology-operated ultrasound-guided thoracentesis is exceedingly low (0.46%), and routine post-procedure chest radiographs in asymptomatic patients provide little value. Reserving post-procedure chest radiographs for patients with post-procedure dyspnea or hypoxia will result in more efficient resource utilization and health care cost savings.

Tuberculosis Risk Stratification of Psoriatic Patients Before Anti-TNF-α Treatment.

Psoriasis is a skin inflammatory condition for which significant progress has been made in its management by the use of targeted biological drugs. Detection of latent M. tuberculosis infection (LTBI) is mandatory before starting biotherapy that is associated with reactivation risk. Together with evaluation of TB risk factors and chest radiographs, tuberculin skin tests (TST) and/or blood interferon-γ-release assays (IGRA), like the QuantiFERON (QFT), are usually performed to diagnose M. tuberculosis infection. Using this approach, 14/49 psoriatic patients prospectively included in this study were identified as LTBI (14 TST+, induration size ≥ 10mm, 8 QFT+), and 7/14 received prophylactic anti-TB treatment, the other 7 reporting past-treatment. As the specificity and sensitivity of these tests were challenged, we evaluated the added value of an IGRA in response to a mycobacterial antigen associated with latency, the heparin-binding haemagglutinin (HBHA). All but one TST+ patient had a positive HBHA-IGRA, indicating higher sensitivity than the QFT. The HBHA-IGRA was also positive for 12/35 TST-QFT- patients. Measurement for 15 psoriatic patients (12 with HBHA-IGRA+) of 8 chemokines in addition to IFN-γ revealed a broad array of HBHA-induced chemokines for TST+QFT- and TST-QFT- patients, compared to a more restricted pattern for TST+QFT+ patients. This allowed us to define subgroups within psoriatic patients characterized by different immune responses to M. tuberculosis antigens that may be associated to different risk levels of reactivation of the infection. This approach may help in prioritizing patients who should receive prophylactic anti-TB treatment before starting biotherapies in order to reduce their number.

Pulmonary Echinococcosis or Lung Hydatidosis: A Narrative Review.

Background: Lung hydatidosis is a zoonosis related to infection by the Echinococcus tapeworm species. Lung involvement in this condition is second only to the liver echinococcosis. Diagnosis ordinarily results from an accidental finding in a direct chest radiograph evaluation because of the delayed growth of the cysts. Moreover, a consistent treatment regimen or approach may not be feasible because of the variability of pulmonary echinococcosis. In this review, we expect to sum up the main features of lung hydatidosis with a perspective on medical and surgical treatment. Methods: Cochrane Library and PubMed were the databases used to perform a narrative literature review. Search terms included "pulmonary echinococcosis" and "lung hydatidosis." The MeSH terms were "lung" [All Fields] AND {"echinococcosis" [MeSH Terms] OR ("hydatidosis" [All Fields] OR "pulmonary" [All Fields] AND "echinococcosis" [All Fields] OR "hydatidosis." A search period from September 1980 to May 2020 was chosen to compare studies from different decades, given the changes in pulmonary echinococcosis management. Results: A uniform treatment regimen or approach may not be feasible because of the variability of pulmonary echinococcosis. No clinical trials have analyzed and compared all the diverse treatment approaches. Cyst size, characteristics, position in the lung and clinical presentation, and the availability of medical/surgical expertise and equipment are the mainstays of echinococcosis management. When feasible, surgery is as yet the principal therapeutic choice to eliminate the cysts; anti-parasitic drugs may minimize complications during high-risk surgery or be used as definitive therapy in some instances with contraindications to surgery. Conclusions: Lung hydatidosis management must become less heterogeneous. We support treatment directed to the subject established on the clinical scenario, host factors, and surgical risk. Strict cooperation in this process between infectious disease specialists and surgeons may optimize best practices to help create shared practical guidelines to simplify clinicians' decision-making. Furthermore, we need a consensus for lung hydatidosis treatment and inserting this disease to global surgery agenda will have a positive impact on acquiring high-quality data that enables us to create an evidence-based guideline for this disease.

Evaluation of Chest Radiographs of Children with Newly Diagnosed Acute Lymphoblastic Leukemia

To evaluate the diagnostic yield of baseline chest radiographs (CXRs) of children with acute lymphoblastic leukemia (ALL). We reviewed the CXR findings at diagnosis for 990 patients aged 1-18years with ALL treated during the Total XV and XVI studies at St. Jude Children's Research Hospital and evaluated the associations of these findings with clinical characteristics and initial management. Common findings were peribronchial/perihilar thickening (n=187 [19.0%]), pulmonary opacity/infiltrate (n=159 [16.1%]), pleural effusion/thickening (n=109 [11.1%]), mediastinal mass (n=107 [10.9%]), and cardiomegaly (n=68 [6.9%]). Portable CXRs provided results comparable with those obtained with 2-view films. Forty of 107 patients with a mediastinal mass (37.4%) had tracheal deviation/compression. Mediastinal mass, pleural effusion/thickening, and tracheal deviation/compression were more often associated with T-cell ALL than with B-cell ALL (P<.001 for all). Pulmonary opacity/infiltrate was associated with younger age (P=.003) and was more common in T-cell ALL than in B-cell ALL (P=.001). Peribronchial/perihilar thickening was associated with younger age (P<.001) and with positive central nervous system disease (P=.012). Patients with cardiomegaly were younger (P=.031), more often black than white (P=.007), and more often categorized as low risk than standard/high risk (P=.017). Patients with a mediastinal mass, pleural effusion/thickening, tracheal deviation/compression, or pulmonary opacity/infiltrate were more likely to receive less invasive sedation and more intensive care unit admissions and respiratory support (P≤.001 for all). Cardiomegaly was associated with intensive care unit admission (P=.008). No patients died of cardiorespiratory events during the initial 7days of management. The CXR can detect various intrathoracic lesions and is helpful in planning initial management.

Abstract No. 577 Limited clinical utility of chest radiography in asymptomatic patients after interventional radiology-performed ultrasound-guided thoracentesis: analysis of 3022 consecutive patients

To report the utility of chest radiography following interventional radiology (IR)–performed ultrasound-guided thoracentesis. A total of 3998 patients underwent thoracentesis between 2003-2018 at two institutions. A total of 3022 (75.6%) patients were >18 years old, underwent IR-performed ultrasound-guided thoracentesis, and had same-day post procedure chest radiograph evaluation. Patient age (years), laterality of thoracentesis, procedural technical success, volume of fluid removed (mL), method of post procedure chest imaging, absence or presence of pneumothorax, pneumothorax size (mm), pneumothorax management measures, and clinical outcomes were recorded. IR-performed ultrasound-guided thoracentesis was performed on the left (n = 1531; 50.7%), right (n = 1477; 48.9%), and bilaterally (n = 14; 0.5%) using 5-French catheters. Technical success was 100% (n = 3022). Mean volume of 940 ± 550 mL of fluid was removed. Postprocedural pneumothorax was identified in 21 (0.69%) patients. Mean pneumothorax size, measured on chest radiograph as the longest distance from the chest wall to the lung pleural reflection, was 18.8 ± 10.2 mm (range, 5.0-35.0 mm). Of the 21 pneumothoraces, 7 (33.3%) resolved spontaneously and had a mean size of 6.4 ± 2.4 mm. Fourteen pneumothoraces, of mean size 25.0 ± 5.8 mm, required management with a pleural drainage catheter (66.6%). The overall incidence of pneumothorax requiring pleural drainage catheter placement following IR-performed ultrasound-guided thoracentesis was 0.46% (14/3022). Of the patients requiring drainage catheter placement, 12/14 (85.7%) and 13/14 (92.9%) had dyspnea and hypoxia, respectively. Potential costs to Medicare and Medicaid, for chest radiographs, in this study, were $27,547 and $10,581, respectively. The incidence of clinically significant pneumothorax requiring catheter drainage is exceedingly low (0.46%), and routine post procedure chest radiographs in asymptomatic patients provide little value. Reserving post procedure chest radiographs for patients with post procedure dyspnea or hypoxia will result in more efficient resource utilization and health care cost savings.Table 1Thoracenteses and Post-Procedural Chest Radiograph ResultsVariableOutcomeLaterality of EffusionLeft1,531 (50.7%)Right1,477 (48.9%)Bilateral14 (0.5%)Mean Volume Removed940 mL (550 mL)Chest Radiograph Technique Portable78 (2.6%)One View513 (17.0%)Two Views2,355 (77.9%)Three Views76 (2.5%)Post-Procedural Pneumothorax21 (0.69%)Mean Pneumothorax Size18.8 (10.2 mm) Open table in a new tab

Prediction of Pulmonary to Systemic Flow Ratio in Patients With Congenital Heart Disease Using Deep Learning–Based Analysis of Chest Radiographs

Chest radiography is a useful noninvasive modality to evaluate pulmonary blood flow status in patients with congenital heart disease. However, the predictive value of chest radiography is limited by the subjective and qualitive nature of the interpretation. Recently, deep learning has been used to analyze various images, but it has not been applied to analyzing chest radiographs in such patients. To develop and validate a quantitative method to predict the pulmonary to systemic flow ratio from chest radiographs using deep learning. This retrospective observational study included 1031 cardiac catheterizations performed for 657 patients from January 1, 2005, to April 30, 2019, at a tertiary center. Catheterizations without the Fick-derived pulmonary to systemic flow ratio or chest radiography performed within 1 month before catheterization were excluded. Seventy-eight patients (100 catheterizations) were randomly assigned for evaluation. A deep learning model that predicts the pulmonary to systemic flow ratio from chest radiographs was developed using the method of transfer learning. Whether the model can predict the pulmonary to systemic flow ratio from chest radiographs was evaluated using the intraclass correlation coefficient and Bland-Altman analysis. The diagnostic concordance rate was compared with 3 certified pediatric cardiologists. The diagnostic performance for a high pulmonary to systemic flow ratio of 2.0 or more was evaluated using cross tabulation and a receiver operating characteristic curve. The study included 1031 catheterizations in 657 patients (522 males [51%]; median age, 3.4 years [interquartile range, 1.2-8.6 years]), in whom the mean (SD) Fick-derived pulmonary to systemic flow ratio was 1.43 (0.95). Diagnosis included congenital heart disease in 1008 catheterizations (98%). The intraclass correlation coefficient for the Fick-derived and deep learning-derived pulmonary to systemic flow ratio was 0.68, the log-transformed bias was 0.02, and the log-transformed precision was 0.12. The diagnostic concordance rate of the deep learning model was significantly higher than that of the experts (correctly classified 64 of 100 vs 49 of 100 chest radiographs; P = .02 [McNemar test]). For detecting a high pulmonary to systemic flow ratio, the sensitivity of the deep learning model was 0.47, the specificity was 0.95, and the area under the receiver operating curve was 0.88. The present investigation demonstrated that deep learning-based analysis of chest radiographs predicted the pulmonary to systemic flow ratio in patients with congenital heart disease. These findings suggest that the deep learning-based approach may confer an objective and quantitative evaluation of chest radiographs in the congenital heart disease clinic.

Breast Implant Prevalence in the Dutch Female Population Assessed by Chest Radiographs

BackgroundBreast implant-related health problems are a subject of fierce debate. Reliable population-based estimates of implant prevalence rates are not available, however, due to a lack of historical registries and incomplete sales data, precluding absolute risk assessments.ObjectivesThis study aimed to describe the methodology of a novel procedure to determine Dutch breast implant prevalence based on the evaluation of routine chest radiographs.MethodsThe validity of the new method was first examined in a separate study. Eight reviewers examined a series of 180 chest radiographs with (n = 60) or without (n = 120) a breast implant confirmed by a computed tomography or magnetic resonance imaging scan. After a consensus meeting with best-performing expert reviewers, we reviewed 3000 chest radiographs of women aged 20 to 70 years in 2 large regional hospitals in the Netherlands in 2015. To calculate the national breast implant prevalence, regional prevalence variations were corrected utilizing the National Breast Cancer Screening Program.ResultsEight reviewers scored with a median sensitivity of 71.7% (range, 41.7%-85.0%) and a median specificity of 94.6% (range, 73.4%-97.5%). After a consensus meeting and a reevaluation by best-performing expert reviewers, sensitivity was 79.9% and specificity was 99.2%. The estimated national prevalence of breast implants among women between 20 and 70 years was 3.0%, ranging from 1.7% at 21 to 30 years to 3.9% between 51 and 60 years.ConclusionsThe novel method in this study was validated with a high sensitivity and specificity, resulting in accurate prevalence estimates and providing the opportunity to conduct absolute risk assessment studies on the health consequences of breast implants.Level of Evidence: 2

Evaluation of Chest Radiographs and Laboratory Testing during Melanoma Staging Procedures

Chest radiographs (CXRs) and laboratory testing have historically been performed as a part of low-risk melanoma (clinical stage 1/2) workup. This study evaluates the utility of routine CXRs and laboratory testing during the staging of clinical stage 1 and 2 melanoma patients. This study was approved by the Institutional Review Board at Wake Forest University. A database of sentinel lymph node biopsies performed for clinical stage 1 or 2 melanoma was used to identify early-stage melanoma patients. The medical records of patients with melanoma were reviewed and preoperative workup procedures were recorded. Four hundred sixty-three patients were reviewed. A total of 315 patients underwent a preoperative CXR, whereas 309 received some laboratory testing. After sentinel node biopsies, 168 patients had pathologic stage 1 disease, 103 stage 2, and 44 stage 3. None of the CXRs (0%) correctly identified metastatic melanoma. Suspicious locations on CXRs and laboratory testing did not lead to metastatic findings in any patient within a year. Metastatic melanoma was not found in any patient by screening with CXRs or laboratory testing during preoperative workup. We recommend not conducting CXRs or laboratory testing during workup for surgical melanoma patients because of charges and anxiety these tests can cause. CXRs, blood tests, and metabolic panels have historically been ordered for early melanoma patients, although debate remains on their efficacy. Surgical patient records were retrospectively reviewed for these tests and no benefit was found.

Evaluation of the Isoniazid Preventive Therapy Care Cascade Among HIV-Positive Female Sex Workers in Mombasa, Kenya.

Kenyan female sex workers (FSWs) have a high HIV prevalence, increasing their tuberculosis (TB) risk. Despite recommendations that HIV-positive individuals be offered isoniazid preventive therapy (IPT), uptake has been limited. In this longitudinal cohort of HIV-positive FSWs, we retrospectively characterized the IPT care cascade between March 2000 and January 2010, including reasons for cascade loss or appropriate exit. Cascade success required completion of 6 months of IPT. Baseline characteristics were assessed as potential correlates of cascade loss using multivariable logistic regression. Among 642 HIV-positive FSWs eligible for IPT evaluation, median age was 31 years (IQR 26-35) with median CD4 lymphocyte count of 409 (IQR 292-604) cells per cubic millimeter. There were 249 (39%) women who successfully completed 6 months of IPT, 157 (24%) appropriately exited the cascade, and 236 (37%) were cascade losses. Most cascade losses occurred at symptom screen (38%, 90/236), chest radiograph evaluation (28%, 66/236), or during IPT treatment (30%, 71/236). Twenty-nine women were diagnosed with tuberculosis, including one after IPT initiation. Most women initiating IPT completed the course (71%, 249/351); <5% had medication intolerance. Younger women [<25 and 25-35 vs. >35 years; adjusted odds ratio (AOR) 2.65, 95% confidence interval (CI): 1.46 to 4.80 and AOR 1.78, 95% CI: 1.13 to 2.80, respectively], and those evaluated for IPT after antiretroviral availability in 2004 (AOR 1.92, 95% CI: 1.31 to 2.81), were more likely to be cascade losses. Implementation of IPT among HIV-positive FSWs in Kenya is feasible. However, significant losses along the IPT care cascade underscore the need for strategies improving retention in care.

H1N1 influenza: Characterization of initial chest radiographic findings and prognostic value of serial chest radiographs

ObjectiveThe aim of this study was to recognize and characterize the initial chest radiographic findings of H1N1 infection and to evaluate whether serial chest radiographs were useful in assessing the severity of infection and predicting the clinical outcome. Materials and methods27 patients hospitalized for H1N1 infection, from January 2015 to May 2016 were retrospectively evaluated, including 17 (62.9%) female patients and 10 (37.1%) male patients, with age ranging between 2 days and 65 years. Radiographs obtained at the time of admission were reviewed and studied for characteristic imaging patterns, laterality (unilateral or bilateral) and zonal distribution of the opacities. Serial chest radiographs taken were reviewed to look for progression or resolution of the imaging findings and compared with the final outcome. ResultsOf the female patients, 4 (23%) were pregnant and 1 (6%) was in the immediate post-partum period. Of the 27 patients, 25 (92.6%) had abnormal and 2 (7.4%) had normal radiological findings on initial chest radiographic appearance. One patient was lost to follow-up, 16 (62%) of the remaining 26 succumbed to the disease while the remaining 10 (38%) improved. Three of the pregnant patients and the postpartum patient had adverse outcomes. Involvement of greater than 4 lung zones and bilateral involvement indicated a poor prognosis. Abnormal chest radiographic findings included consolidation, peribronchial cuffing, nodular opacities and reticulo-nodular opacities, with the most common being consolidation with or without peribronchial cuffing. Patients with more than 4 zones of involvement invariably had an adverse clinical outcome. ConclusionInitial chest radiographic findings help in diagnosing the type of pneumonia, and consolidation associated with peribronchial cuffing is a common finding in viral pneumonia like H1N1. Prognosis based on evaluation and monitoring of serial chest radiographs is a valuable tool in predicting the final clinical outcome of the patient. Extensive involvement of both lungs, in the form of multi-zonal and bilateral lung opacities is frequently associated with adverse prognosis.

Role of emergent chest radiography in evaluation of hyperacute stroke.

To use data from a large multicenter trial to assess the role and significance of chest radiograph (CXR) in the initial evaluation of acute stroke. Predefined clinical characteristics of patients who had recorded data on CXR examination during the initial evaluation were collected. We compared features of patients who had a CXR done before IV thrombolytics with those who did not. Rates of adverse cardiopulmonary events, intubation, and in-hospital mortality were also compared. Logistic regression analysis was performed to evaluate for the association of CXR performance with door-to-needle time ≥60 minutes. In a cohort of 615 patients, 243 had CXR done before IV thrombolytics. Patients with CXR before treatment had significantly higher admission neurologic deficit, initial respiratory rates, and door-to-needle time than those with CXR after treatment. The rates of cardiopulmonary adverse events in the first 24 hours of admission, endotracheal intubation in the first 7 hours, and in-hospital mortality were not different between the 2 groups. Patients with CXR done before treatment had longer mean door-to-needle times than those without pretreatment radiography (75.8 vs 58.3 minutes, p = 0.0001). Performance of CXR was independently associated with door-to-needle time ≥60 minutes (odds ratio 2.78, 95% confidence interval 1.97-3.92; p = 0.00001). Performance of CXR prior to IV thrombolytics prolongs door-to-needle time in acute ischemic stroke patients. CXR before treatment should be reserved for situations wherein acute cardiopulmonary conditions would otherwise preclude the administration of IV thrombolytics or substantially influence management.

Sebaceous lymphadenoma of the thymus: A clinicopathologic and immunohistochemical study of 2 cases

Two cases of primary sebaceous lymphadenoma of the thymus are presented. The patients were a man and a woman 58 and 77 years old, respectively. The female patient had a history of breast carcinoma and on follow-up was identified to have an anterior mediastinal mass; the male patient did not have any history of malignancy, and the tumor was discovered during a chest radiographic evaluation when the patient presented with symptoms of fatigue, chest pain, and dyspnea. Histologically, both lesions were characterized by the presence of solid-cystic epithelial islands in a prominent lymphocytic background. The epithelial islands were haphazardly distributed in the form of small tubular structures with focal keratinization and groups of epithelial cells with clear cytoplasm, round nuclei and lack of mitotic activity in keeping with sebaceous cells. The presence of germinal centers in the lymphoid background was seen in both cases. Immunohistochemically, the epithelial component was positive for cytokeratin 8 (CAM5.2), cytokeratin 5/6, and for adipophilin in the sebaceous component. B- and T-cell markers were positive in the lymphoid component. Clinical follow-up in both patients showed that the 2 patients were well and alive 3 years after diagnosis. The cases herein presented expand the spectrum of salivary gland-type tumors in the mediastinum and raise awareness of lesions which are easily confused with other more common thymic tumors that have different prognosis and treatment implications.

Prevalence and pattern of cervical rib, transversomegaly and other vertebral anomalies in normal adult cervical spine in Kumaon region of Uttarakhand, India

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; A supernumary rib from seventh cervical vertebra is called cervical rib and is a common anomaly. Its true prevalence is not validated as most of these are asymptomatic thus do not get diagnosed. Its incidence has been reported in several geographic regions and ethnic clusters. Most of the studies rely on radiological data collected from evaluation of chest or neck radiographs of defined numbers.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A similar study to ascertain its presence and incidence, apart from sexual and morphological pattern is required for Kumaon region of Uttarakhand, India. The present study reports data extracted from study of 1500 radiographs and evaluating them for presence of cervical rib and other abnormalities. Demographic and other relevant details were noted.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Most of the cases were female and almost all cases of cervical rib or transversomegaly were bilateral. 0.8% and 1.4% cases were noted for cervical rib and transversomegaly respectively. Apart from it, 4 cases of vertebrae fusion and one case of hemi-vertebra leading to cervical scoliosis was also noted.&lt;/p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The prevalence of cervical rib was comparable to other studies considering the sample size. The calculation of true incidence however will require multi-discipline collaboration and robust data. This study, however, is important for further work in this regard and adds value to existing literature.

The prevalence of cervical ribs in Enugu, Nigeria.

Cervical rib is an important cause of nontraumatic thoracic outlet neurovascular compression. This study was undertaken as there is no known documented report on its prevalence in the study environment. To evaluate the prevalence of cervical ribs and its variation with sex and age among patients presenting at radiological facilities for a chest radiograph. Retrospective evaluation of plain posterior-anterior view chest radiographs done in radiological facilities in Enugu, Southeast, Nigeria. Evaluated in this study were all 6571 chest radiographs consecutively obtained between 2009 and 2012 in three randomly selected radiological facilities in Enugu. SPSS version 17 software was used in data analysis. Chi-square and student t-tests were used to test for the significance of findings at 95% confidence level. This study reports the overall prevalence of cervical ribs as 48 (0.7%) with a significantly higher rate in females 43 (1.1%) when compared to males 5 (0.2%) (P = 0.000). In 27 (0.4%) cases, the cervical ribs were bilateral; whereas in 21 (0.3%) cases, they were unilateral with 8 (0.1%) on the left and 13 (0.2%) on the right. There was no age-related variability with prevalence (P = -0.813). The prevalence of cervical rib in the study population is low and within the known range as seen in other geographical regions of Nigeria.

Robust and Reproducible Quantification of the Extent of Chest Radiographic Abnormalities (And It’s Free!)

RationaleObjective, reproducible quantification of the extent of abnormalities seen on a chest radiograph would improve the user-friendliness of a previously proposed severity scoring system for pulmonary tuberculosis and could be helpful in monitoring response to therapy, including in clinical trials.MethodsIn this study we report the development and evaluation of a simple tool using free image editing software (GIMP) to accurately and reproducibly quantify the area of affected lung on the chest radiograph of tuberculosis patients. As part of a pharmacokinetic study in Lima, Peru, a chest radiograph was performed on patients with pulmonary tuberculosis and this was subsequently photographed using a digital camera. The GIMP software was used by two independent and trained readers to estimate the extent of affected lung (expressed as a percentage of total lung area) in each radiograph and the resulting radiographic SCORE.Results56 chest radiographs were included in the reading analysis. The Intraclass correlation coefficient (ICC) between the 2 observers was 0.977 (p<0.001) for the area of lung affected and was 0.955 (p<0.001) for the final score; and the kappa coefficient of Interobserver agreement for both the area of lung affected and the score were 0.9 (p<0.001) and 0.86 (p<0.001) respectively.ConclusionsThis high level of between-observer agreement suggests that this freely available software could constitute a simple and useful tool for robust evaluation of individual and serial chest radiographs.