Chest X-ray Film Research Articles

Evaluation of Three Pneumothorax Size Quantification Methods on Digitized Chest X-ray Films Using Medical-Grade Grayscale and Consumer-Grade Color Displays

This study focused on the effects of pneumothorax size quantification in digital radiology environments when a quantification method is selected according to the radiologist's criteria. The objective of this study was to assess the effects of factors, including the radiologist (with different experience), displays (medical-grade and consumer-grade displays), or display calibration, on the Rhea, Collins, and Light quantification methods. This study used a factorial design with 76 cases, including 16 pneumothorax cases observed by six radiologists on three displays with and without the DICOM standard calibration. The gold standard was established by two radiologists by using computed tomography. Analysis of variance (ANOVA) was performed on the pneumothorax sizes. For the three quantifications methods, none of the evaluated factors were significant. We conclude that radiologists, displays, and calibration do not significantly affect the quantification of pneumothorax size in different digital radiology environments.

Herniation of transverse colon into mediastinum after pedicled omental grafting for mediastinitis: report of a case

We describe a rare complication and the treating experience of it after pedicled omental grafting for mediastinitis. The patient was diagnosed as an acute mediastinitis soon after the total arch replacement was performed. A two-staged strategy to treat postoperative mediastinitis was scheduled, i.e., the setting up of a vacuum-assisted closure system until the improvement of inflammation followed by wound closure with pedicled omental grafting. The treatment for acute mediastinitis was successful and the patient followed a favorable postoperative course. During the follow-up, chest X-ray film suggested the gradual enlargement of mediastinum and CT showed the herniation of transverse colon into mediastinum. Surgical correction for the hernia was scheduled and performed successfully by the laparoscopic procedure to prevent a possible cardiac and pulmonary dysfunction.

Clinical research on the incision line selection of video-assisted thoracoscopic wedge resection of the lung

ObjectiveTo compare the clinical efficacy of video-assisted thoracoscopic direct lung wedge resection (banana peel method) with that of the opposite resection line (traditional method). MethodsReview and analysis of 83 cases of video-assisted thoracoscopic wedge resections of lung operations from February 2007 to September 2011. All of the patients were divided into two groups, as follows: Group A: wedge resection of the lung by the opposite resection line (traditional method), 41 cases; Group B: direct lung wedge resection (banana peel method), 42 cases. Both of the groups received video-assisted thoracic surgery. The postoperative follow-up period was 1–6 months, with an average of 3.6 months. The operating conditions (including operation time, transoperative bleeding volume, number of transoperative sutures added, postoperative time to extubation, surgery cost, number of suturing instruments used for incising with the endoscope and the cost of hospitalisation), atelectasis conditions 1 month after the operation and the decreasing lung function conditions were compared between groups. ResultsGroup B's operative time was (62 ± 10) min, significantly less than Group A's (81 ± 16) min (P < 0.05). The amount of bleeding in Group B was (52 ± 17) ml, which was also significantly less than that of Group A, at (74 ± 21) ml (P < 0.05). Compared to Group A, Group B had significantly (P < 0.05) fewer manual sutures and shorter postoperative extubation times. The cost of surgery and number of endoscopic staplers used during the operation in Group B were significantly larger than in Group A; however, the total hospital costs did not differ between the two groups (P > 0.05). Neither group had any cases of atelectasis based on chest X-ray films taken 1 month after the operation, and no difference was found in the groups' decreased lung functions. ConclusionsThe video-assisted thoracoscopic direct lung wedge resection (banana peel method) can shorten the operative time, lessen the surgical trauma, reduce the number of additional manual sutures required, and make for an overall more convenient operation, compared to wedge resection of lung by opposite resection line (traditional method). Although operation costs have increased, the total hospital costs have not. Thus, the better choice for video-assisted thoracoscopic lung wedge resections involves the use of direct lung wedge resection.

A Case of Primary Lymphoplasmacytic Lymphoma Limited to the Paratracheal Mediastinum

A 54 year old Japanese man was introduced to Saiseikai General hospital for an evaluation of an abnormal chest X-ray film. Abnormal soft tissue area was observed in the mediastinum surrounding anterior area of the trachea on chest CT. Because the mediastinal tumor showed slow enlargement after temporal decrease and surgical resection of the tumor was performed 3 years after the first visit. Pathologically, diffuse proliferation of oval-shaped plasmacytic or small lymphocytic cells with eccentrically-located nuclei with rough chromatin were observed in the tumor. Immunohistochemically, these cells were positive for CD20, weakly positive for IgM, negative for CD3, CD5, CD10, suggesting lymphoplasmacytic lymphoma (LPL). The patient was treated with rituximab after the surgical treatment, and showed no exacerbation for 3.5 years after surgery. LPL localized to the paratracheal mediastinum is rare, and a surgical approach is important for prompt and proper diagnosis.

Surgical Technique Influences HeartMate II Left Ventricular Assist Device Thrombosis

Thrombosis of the HeartMate II (HM2 [Thoratec Corporation, Pleasanton, CA]) is a potentially devastating complication. While attention has been focused on anticoagulation strategies to prevent this complication, the impact of surgical technique has not been assessed. Patients undergoing HM2 implantation at two institutions were reviewed. Pump thrombosis (PT) was defined as a clinical syndrome that included more than 30% elevation in pump power, more than 30% elevation in lactate dehydrogenase, and greater than 20% decrease in hemoglobin with the presence of thrombus in the HM2 stator or rotor, or both, at explant or autopsy. A blinded clinician reviewed dimensions and angles of the HM2 obtained from chest x-ray films. Patients demonstrating PT were compared with patients having normal function. Of the 49 patients reviewed, 11 (22.4%) displayed evidence of PT at a median of 42 days after HM2 implantation. Patient with PT had greater acute angulation of the HM2 inflow cannula immediately postoperatively (48.2 ± 6.8 versus 65.4 ± 9.2 degrees, p < 0.001) and after 30 days (50.1 ± 8.0 versus 65.1 ± 9.9 degrees, p < 0.001). Pump pocket depth was lower in the PT group immediately after HM2 implantation (107.0 ± 41.9 versus 144.3 ± 20.3 cm, p < 0.001) and after 30 days (86.0 ± 39.1 versus 113.1 ± 25.4 cm, p= 0.02). Patients with evidence of PT did not have a decrease in end-diastolic diameter (76 ± 9 versus 70 ± 15 mm, p= 0.24) whereas patients in the normal function group had effective remodeling of the left ventricle (70 ± 10 versus 56 ± 12 mm, p= 0.01). Meticulous surgical technique, which necessitates creating an adequately sized pump pocket and appropriately directing the inflow cannula at the time of operation, may reduce the risk of PT.

Misdiagnosis of pneumoconiosis or silicotuberculosis in China: a pooled analysis of 1178 cases

To investigate the situation and causes of misdiagnosis of pneumoconiosis or silicotuberculosis in China by pooled analysis, and to provide a reference for the clinical diagnosis of pneumoconiosis in China and reduce the misdiagnosis rate. A computer search was performed to collect the studies on the misdiagnosis of pneumoconiosis or silicotuberculosis published in China from 1985 to 2013. The obtained data were subjected to pooled analysis to investigate the causes of misdiagnosis and seek the measures for reducing misdiagnosis. Fifty-nine studies involving 1178 cases of misdiagnosed pneumoconiosis or silicotuberculosis were collected. There were 13 causes of misdiagnosis, and the most common one was the poor ability of identification due to inadequate experience in reading chest X-ray films (45.93%), followed by neglect of patient's occupational history (44.99%). Other causes of misdiagnosis included complex X-ray findings that are difficult to judge (29.03%), poor quality of chest radiographs (23.09%), and lack of regular health supervision (19.95%). Inadequate experience of physicians is the main cause of misdiagnosis of pneumoconiosis or silicotuberculosis. To reduce misdiagnosis of the disease, measures should be taken to enhance the training and evaluation of knowledge and skills of diagnosis and differential diagnosis of pneumoconiosis among physicians.

P2.025 Etiology of Respiratory Tract Infection in HIV/AIDS Patients at the National Hospital of Tropical Diseases (NHTD) Hanoi, Vietnam

BackgroundRespiratory tract infection is leading causes of death among patients infected with human immunodeficiency virus in Vietnam. Identification the agents caused RTIs is very important to give specific treatment and...

PTU-011 A Survey on Provision of Teaching for Nasogastric Tube Placement as part of the Curricula of UK Medical Schools: Abstract PTU-011 Table 1

<h3>Introduction</h3> Nasogastric tube (NGT) insertion for enteral feeding is common practise, but is associated with the risk of tube misplacement or malposition in both the immediate and subsequent time points.¹ Between 2005 to 2010, 21 deaths and 79 other cases of harm have been reported on the updated National Patient Safety Agency (NPSA) Alert (2011), “Reducing harm caused by nasogastric feeding tubes”. In 45% of cases, misinterpretation of the chest X-ray was directly responsible for the harm inflicted. The General Medical Council’s (GMC) guidance for undergraduate education, “Tomorrow’s Doctors (2009)” does not specify NGT placement as a core competency for a graduate or Foundation Trainee.² The purpose of this survey was to ascertain the number of medical schools in the United Kingdom (UK) which provide specific teaching on NGT placement and correct identification of tube position (using either pH method or clinical interpretation of a plain chest X-ray film). Furthermore, the authors sought to identify whether these medical schools included formative or summative assessment of the respective methods. <h3>Methods</h3> All 30 GMC recognised Medical Schools within the UK were invited to participate by means of a standardised survey proforma. This proforma was emailed to relevant staff members who were either responsible for course development or were personnel within the clinical skills faculty. <h3>Results</h3> To date, there has been a 57% (17/30) response rate (<i>Table 1</i>). Of the 10 medical schools that provide formal teaching on NGT insertion, 8 of them required formative assessment for both the practical technique and the interpretation of correct tube position. Of the 7 medical schools that do not to provide formal teaching of NGT insertion, 6 of them stated that this was due to the GMC’s “Tomorrow’s Doctors” guidance not including NGT placement as a mandatory proficiency for a graduate. <h3>Conclusion</h3> This survey found that 59% (10/17) of the participating UK medical schools provide formal teaching on NGT placement and correct identification of tube position. There is variable emphasis on NGT procedure proficiency in undergraduate medical education. Given the risks highlighted by the 2011 NPSA report, we would suggest that NGT placement instruction and training should be facilitated at the undergraduate level. <h3>Disclosure of Interest</h3> None Declared <h3>References</h3> National Patient Safety Alert (PSA 002): Reducing the harm caused by misplaced nasogastric feeding tubes in adults, children and infants; Mar 2011. URL: http://www.nrls.npsa.nhs.uk/alerts/?entryid45 = 129640 General Medical Council (GMC) Tomorrow’s Doctors 2009; URL: http://www .gmc-uk.org/TomorrowsDoctors_2009.pdf_39260971.pdf

Serial hemodynamic assessment using Doppler echocardiography in a fetus with left ventricular aneurysm presented as fetal hydrops

A 22-week fetus presented with a large left ventricular aneurysm, 24 × 21 × 18 mm in size, detected by abnormal four-chamber view, and severe fetal hydrops with pericardial effusion, ascites and skin edema. The aneurysm was thin-walled, hypokinetic, and had enlarged with gestational age, causing compression of the lung. Although the left ventricular function had progressively impaired as expressed by increase in Tei index, hydrops had resolved by 32 weeks of gestation, probably because of maternal digoxin therapy and successful compensation by the right ventricle, as represented by retrograde blood flow in the distal aortic arch via the patent arterial duct. Because of the significant risk of severe cardiorespiratory failure, we transported the mother to a neonatal cardiac surgical center at 38 weeks of gestation. Indeed, the baby showed severe cardiopulmonary failure after birth, showing 100% of cardiothoracic ratio on the chest X-ray film, but was saved by the successful Dor procedure, including surgical resection of the aneurysm at 10 h of life. In this case, serial echocardiographic evaluation can allow us to monitor the hemodynamics and lead to successful postnatal management.

A Low Cost Method of Digitizing Radiographs Using a Photo Light Box

We evaluated a low cost device for digitizing X-ray films. It consisted of a locally-made wooden box and a readily-available digital camera. Two experienced paediatric radiologists interpreted the original X-ray films (the reference standard) and the corresponding images obtained in the photo light box. Ninety paediatric chest X-ray films were used (30 were normal chest radiographs, 30 showed pneumonic-consolidation and 30 had interstitial infiltrates). The presence or absence of the three signs most frequently found in acute respiratory pathologies were evaluated: normal pulmonary transparency, pneumonic consolidation and interstitial infiltration. There was very good agreement between the X-ray films and the digitized images, with kappa values from 0.86 to 0.98. There was good agreement between the two observers, with kappa values from 0.67 to 0.90. The low-cost photo light box represents an accessible and low-cost approach to transmitting X-ray images, allowing findings or a second opinion from a specialist radiologist to be obtained from a distance.

Clinical follow-up studies of pediatric idiopathic pulmonary hemosiderosis

Objective To describe the clinical characteristics of idiopathic pulmonary hemosiderosis (IPH), and to investigate the possible risk factors for poor prognosis. Methods The clinical data of 41 patients with IPH were retrospectively analyzed, 22 cases were divided into survival group and death group according to the follow-up data and prognosis, and the related clinical factors in 2 groups were statistically analyzed. Results Of the 41 patients with IPH, 14 cases were male, 27 cases female.The median age of onset was 3.8 years, and the diagnosed median age was 4.6 years.The common clinical features of the 41 children with IPH included pale, cough, hemoptysis, fever, and fatigue, in 34 cases (82.9%), 27 cases (65.8%), 16 cases (39.0%), 13 cases (31.7%) and 11 cases (26.8%) children, respectively.Initial symptoms included pale, cough, hemoptysis, in 27 cases(65.9%), 13 cases(31.7%), and 11 cases(26.8%) children, respectively.Accessory examinations revealed microcytic hypochromic anemia (average hemoglobin concentration was 65.2 g/L), and 40 patients (97.6%)had an abnormal chest X-ray.Forty patients were treated with glucocorticoids, and all of them had symptom remission.Twenty-two patients were followed up for 6 months to 9 years, and 6 cases (27.3%)died during follow-up and 16 cases (72.7%) still alive.There were no statistically significant differences between death group and survival group as to age of onset, gender distribution, age on diagnosis, degree of anemia, and clinical features(all P>0.05). The incidence of jaundice was significantly different between the 2 groups(P<0.05). Conclusions IPH has diverse clinical manifestations and a high rate of misdiagnosis.A routine chest X-ray film should be taken for patients with moderate to severe microcytic hypochromic anemia.The conditions of some pediatric patients can be stabilized with glucocorticoids treatment, but the associated mortality rate remains high.History of jaundice may be a risk factor for poor prognosis. Key words: Idiopathic pulmonary hemosiderosis; Prognosis; Child

Imatinib-induced decompensated heart failure in an elderly patient with chronic myeloid leukemia: case report and literature review

Because it is safe and well tolerated, imatinib is a standard first-line therapy for chronic myeloid leukemia (CML). Although there have been sporadic reports of imatinib-induced cardiotoxicity, including left ventricle (LV) dysfunction and heart failure, the evidence for it is contradictory. Here, we reported a case of an 88-year-old male patient with CML developed decompensated heart failure following imatinib therapy. Four days after the initiation of imatinib, the patient developed orthopnea, edema and a pleural effusion accompanied by abdominal distension, nausea and vomiting. The chest X-ray film showed an enlarged cardiac profile. The echocardiogram demonstrated a decreased LV ejection fraction and enlarged left-side cardiac chambers. B-type natriuretic peptide concentrations were markedly increased. The patient recovered soon after the withdrawal of imatinib and introduction of comprehensive therapy for heart failure. Imatinib-induced cardiotoxicity in elderly patients is a potentially serious complication that merits further evaluation.

Aortic Arch Calcification Detectable on Chest X-ray Films is Associated with Plasma Diacron-reactive Oxygen Metabolites in Patients with Type 2 Diabetes but without Cardiovascular Disease

This study aimed to evaluate the relationship between aortic arch calcification (AAC) detectable on chest X-ray films and plasma diacron-reactive oxygen metabolites (d-ROMs) in patients with type 2 diabetes but without cardiovascular disease. Forty-nine patients with type 2 diabetes but without cardiovascular disease were evaluated with chest X-ray examinations and divided into those with AAC (n=26) and those without AAC (n=23). Biochemical variables, including plasma levels of d-ROMS, high-sensitivity C-reactive protein (hsCRP), plasminogen activator inhibitor-1 (PAI-1), and lipoprotein(a) (Lp(a)), were evaluated after an overnight fast. The relationships of AAC with both inflammation and oxidative-stress variables were evaluated. The plasma level of d-ROMs in subjects with AAC was significantly higher than that in subjects without AAC, whereas plasma levels of hsCRP, PAI-1, and Lp(a) in subjects with AAC were higher, but not significantly so, than those in subjects without AAC. Multivariate linear regression analysis with AAC grade as the dependent variable and plasma levels of d-ROMs, hsCRP, PAI-1, or Lp(a) as independent variables demonstrated a significant association of AAC grade with plasma levels of d-ROMs but not with plasma levels of hsCRP, PAI-1, or Lp(a). The plasma level of d-ROMs is associated with AAC in patients with type 2 diabetes but without cardiovascular disease. Hence, the results of the present study suggest that AAC in these patients is strongly associated with oxidative stress. Furthermore, patients with type 2 diabetes and AAC may be at high risk for the development and progression of various diabetic complications induced by oxidative stress.

Is Primary Repair of Tracheobronchial Rupture Curative?

Background: Tracheobronchial disruption as a result of blunt thoracic trauma is a rare entity and only clinically serious lesions come to our notice, which can be life-threatening and need prompt recognition and treatment. Objectives: To review the authors’ experience with tracheobronchial injuries to emphasize the need for prompt diagnosis and treatment to avoid lethal complications including severe hypoxic organ failure, sepsis, mediastinitis and bronchopleural fistula. Patients and methods: A retrospective study of total 32 patients with tracheobronchial injury from 2001 to 2011. This study limited to patients with thoracic tracheal or bronchial injury, excluding those with cervical injuries. The study includes collected information about mechanism of injury, presentation, time until diagnosis and treatment, anatomical site of injury, type of treatment, diagnostic methods, duration of follow up and outcome. Results: Twenty-four patients were male (75%) and eight were females (25%). Patient’s ages ranged from 7 - 53 years. Majority of cases was referred because of blunt trauma in 15 cases (46.8%), 6 (18.75) motor vehicle accident, 5 (15.6%) fall from a height and 4 (12.5%) with trauma by heavy object, while 8 cases (25%) were referred due to penetrating injury and 2 cases (6.25%) due to iatrogenic injury. In initially diagnosed group, the predominant clinical signs that give a suspicion of tracheobronchial disruption were increased subcutaneous surgical emphysema, shortness of breath, hemoptysis. After the admission to emergency unit, all of them were examined radiologically by chest X-ray film. Longitudinal tear of right upper lobe bronchus was found in 8 cases (32%), complete cut of right upper lobe bronchus in 4 cases (16%), tear of right intermediate bronchus in 4 cases (16%), 3 cases with clear cut left upper lobe (12%), longitudinal tear of distal lateral tracheal wall extend to right upper lobe in 2 cases (8%), 2 cases (8%) showed complex disruption of distal trachea right main with carinal tear and 2 cases (8%) with longitudinal tear of membranous wall of the trachea. 17 patients from early diagnosed cases had concomitant comorbid extra thoracic injuries at the time of diagnosis in the form of abdominal trauma in 12 cases, skeletal fractures in 9 cases and head injury in 5 cases. Conclusion: In a patient with a complex bronchial rupture, primary repair of the bronchus can be possible with complete functional preservation of the lung tissue.

Saccular Coronary Artery Aneurysm and Fistula with Organized Thrombi

Saccular coronary artery aneurysm, associated with coronary artery fistula, is a very rare condition. A 48-year-old woman was referred to our hospital for the evaluation of an abnormal shadow on the left cardiac border from a chest X-ray film during regular medical health examination. A huge saccular aneurysm with organized thrombi in the proximal left anterior descending artery (LAD) and coronary artery fistulae from LAD and conus branch of the right coronary artery to pulmonary artery was diagnosed by transthoracic echocardiography, multi-detector computer tomography (MDCT), and coronary angiography. The patient received surgical treatment, including thrombectomy of aneurysm, ligation of the inlet and outlet of aneurysmal sac, coronary artery bypass graft (left internal mammary artery-to-distal LAD), and ligation of fistulae. The postoperative course was uneventful, and postoperative echocardiography and MDCT revealed patent bypass graft; however, a small fistula from proximal LAD across aneurysmal sac to pulmonary artery was observed.

A fascinating presentation of hepatic hydrothorax

We report this case of a 43-year-old woman with hepatitis-C cirrhosis who presented with a large right sided pleural effusion complicated by hypoxic respiratory failure and altered mentation necessitating dependence on mechanical ventilation. The pleural effusion spontaneously resolved upon initiation of mechanical positive pressure ventilation and recurred almost immediately after weaning the patient off the ventilator. The pre-ventilation, ventilation and post-ventilation chest X-ray films in chronological order present a striking visual demonstration of fluid dynamics and pathophysiology of hepatic hydrothorax, thereby obviating the need for a dedicated diagnostic test. We also report this case to highlight the treatment strategies for this often intractable complication.

Giant Congenital Left Atrial Appendage Aneurysm

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4][![Graphic][5] ][5] A 10-year-old girl presented with a 2-month history of atrial fibrillation. Chest x-ray film showed marked cardiomegaly (A) . Transthoracic echocardiography showed a giant (13 × 10 cm) saccular aneurysm

Severe Pneumonia Caused by Streptococcus Pneumoniae and Haemophilus Influenzae Coinfection in an Elderly Patient: A Case Report

An 80-year-old man was admitted to our hospital because of worsening dyspnea, fever and sputum. Both chest X-ray film and computed tomography findings showed localized consolidation of the right lower lung. A urine sample was positive for Streptococcus pneumoniae antigen. After initial treatment with meropenem for 3 days, his symptoms improved and high-dose ampicillin was substituted for meropenem. However, 3 days later he required intubation for adult respiratory distress syndrome. We reinstituted meropenem therapy and this proved successful. Sputum culture revealed coinfection with penicillin sensitive S. pneumoniae and beta-lactamase-negative ampicillin-resistant Haemophilus influenzae . doi: http://dx.doi.org/10.4021/jmc843w

A case of middle mediastinal thymoma

A 56-year-old male was referred to our clinic after an abnormality was found on chest X-ray films during regular health examinations. Middle mediastinal tumor was detected by computed tomography, he was admitted for surgical treatment. The tumor was removed by surgery, and a pathological diagnosis of mixed thymoma (type AB, the World Health Organization Classification) was made by examining the resected specimen. Because the tumor had invaded to its capsule, it was considered to be a stage II thymoma according to the Masaoka staging system. Postoperative radiation therapy (50 Gy) was administered to the mediastinum. The patient has remained disease-free and without any recurrence as of 9 years and 8 months after the operation. We herein present our findings because middle mediastinal thymoma is incredibly rare.

Utility of cervical spinal and abdominal computed tomography in diagnosing occult pneumothorax in patients with blunt trauma

Small pneumothoraces (PXs), which are not initially recognized with a chest x-ray film and diagnosed by a thoracic computed tomography (CT), are described as occult PX (OCPX). The objective of this study was to evaluate cervival spine (C-spine) and abdominal CT (ACT) for diagnosing OCPX and overt PX (OVPX). All patients with blunt trauma who presented consecutively to the emergency department during a 26-months period were included. Among all the chest CTs (CCTs) (6,155 patients) conducted during that period, 254 scans were confirmed to have a true PX. The findings in their C-spine CT and ACT were compared with the findings in CCTs. Among these patients, 254 had a diagnosis of PX confirmed with CCT. OCPXs were identified on the chest computed tomographic scan of 128 patients (70.3%), whereas OVPXs were evident in 54 patients (29.7%). Computed tomographic imaging of the C-spine was performed in 74% of patients with OCPX and 66.7% of patients with OVPX trauma. Only 45 (35.2%) cases of OCPX and 42 (77.8%) cases of OVPX were detected by C-spine CT. ACT was performed in almost all patients, and 121 (95.3%) of 127 of these correctly identified an existing OCPX. Sensitivity of C-spine CT and ACT was 35.1% and 96.5%, respectively; specificity was 100% and 100%, respectively. Almost all OCPXs, regardless of intrathoracic location, could be detected by ACT or by combining C-spine and abdominal computed tomographic screening for patients. If the junction of the first and second vertebra is used as the caudad extent, C-spine CT does not have sufficient power to diagnose more than a third of the cases. Diagnostic study, level III.