Chest X-ray Radiography Research Articles

The chest radiographic appearances of non-tuberculous mycobacterial pulmonary infection in patients with acquired immunodeficiency syndrome

Objective To study the chest radiographic appearances of the non-tuberculous mycobacterial(NTM) pulmonary infection in patients with acquired immune deficiency syndrome (AIDS).Methods Ten patients with AIDS and NTM underwent chest X-ray radiography and 7 patients performed high-resolution CT (HRCT) scan. Chest radiographic features of NTM in patients with AIDS were retrospectively analyzed. Results The chest radiograph showed bilateral pulmonary involvement in 6 cases and single lung involvement in 4 cases (3 cases in the right, 1 case in the left). Patchy air space consolidation (6 cases), large consolidation (5 cases), cavitation (5 cases), small nodules (3 cases),military nodules (2 cases), linear opacity ( 1 cases) were demonstrated on radiography. On HRCT, air space consolidation (7 cases), small nodules (6 cases), large consolidation (5 cases) with cavitation and cylindric bronchiectasis after the absorption of consolidation, enlarged hilar and mediastinal lymph nodes (4 cases), ground-glass opacities (3 cases), military nodules and tree-in-bud sign (2 case), pleural effusion ( 1 case), pericardial effusion ( 1 case) and fibrotic band ( 1 case) were found. Conclusion The most common radiographic appearances of NTM in patients with AIDS are bilateral small nodules, large consolidation with cavitation and cylindric bronchiectasis, enlarged hilar and mediastinal lymph nodes. Key words: Lung diseases; Mycobacterium infections; Acquired immunodeficiency syndrome; Diagnostic imaging

Incidence of and risk factors for interstitial pneumonia in patients with rheumatoid arthritis in a large Japanese observational cohort, IORRA

Interstitial lung disease (ILD) is a frequently encountered and sometimes life-threatening complication among patients with rheumatoid arthritis (RA). In this study, we aim to clarify the incidence of and risk factors for ILD using a large observational cohort of RA patients. We analyzed the database from a large observational cohort of Japanese RA patients, the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) cohort. We defined as interstitial pneumonia (IP) computed tomography (CT) pattern of nonspecific interstitial pneumonia or diffuse alveolar damage. Newly developed IP was identified from patient reports over 2.5 years (April 2004 to October 2006) and was confirmed by extensive medical record, chest X-ray radiograph, and CT. The raw and age/gender-adjusted incidence of IP were reported. IP risk factors were analyzed using a nested case–control design was employed using conditional logistic regression analysis with a stepwise method. Thirty-seven patients among 5,699 RA patients were diagnosed with newly developed IP, including 18 cases with methotrexate-induced pneumonitis (MTX-IP) and 15 cases with IP associated with RA (RA-IP). The age-adjusted incidence of MTX-IP among total patients, males, and females was 3.775, 6.667, and 1.013 per 1,000 cases, respectively, and of RA-IP among total patients, males, and females was 1.056, 1.452, and 0.677 per 1,000 cases, respectively. Conditional logistic regression analysis after stepwise variable selection identified male gender, increased Japanese version of the Health Assessment Questionnaire (J-HAQ) score, decreased pain visual analog scale (VAS), and elevated erythrocyte sedimentation rate as significant risk factors for MTX-IP, while the only risk factor for RA-IP was male gender. The incidence of and risk factors for IP in RA patients were determined in a large observational cohort of RA patients in Japan.

Incidence of and risk factors for interstitial pneumonia in patients with rheumatoid arthritis in a large Japanese observational cohort, IORRA

Interstitial lung disease (ILD) is a frequently encountered and sometimes life-threatening complication among patients with rheumatoid arthritis (RA). In this study, we aim to clarify the incidence of and risk factors for ILD using a large observational cohort of RA patients. We analyzed the database from a large observational cohort of Japanese RA patients, the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) cohort. We defined as interstitial pneumonia (IP) computed tomography (CT) pattern of nonspecific interstitial pneumonia or diffuse alveolar damage. Newly developed IP was identified from patient reports over 2.5 years (April 2004 to October 2006) and was confirmed by extensive medical record, chest X-ray radiograph, and CT. The raw and age/gender-adjusted incidence of IP were reported. IP risk factors were analyzed using a nested case-control design was employed using conditional logistic regression analysis with a stepwise method. Thirty-seven patients among 5,699 RA patients were diagnosed with newly developed IP, including 18 cases with methotrexate-induced pneumonitis (MTX-IP) and 15 cases with IP associated with RA (RA-IP). The age-adjusted incidence of MTX-IP among total patients, males, and females was 3.775, 6.667, and 1.013 per 1,000 cases, respectively, and of RA-IP among total patients, males, and females was 1.056, 1.452, and 0.677 per 1,000 cases, respectively. Conditional logistic regression analysis after stepwise variable selection identified male gender, increased Japanese version of the Health Assessment Questionnaire (J-HAQ) score, decreased pain visual analog scale (VAS), and elevated erythrocyte sedimentation rate as significant risk factors for MTX-IP, while the only risk factor for RA-IP was male gender. The incidence of and risk factors for IP in RA patients were determined in a large observational cohort of RA patients in Japan.

Development of a System that Generates Structured Reports for Chest X-ray Radiography

Radiology reports are typically made in narrative form; this is a barrier to the implementation of advanced applications for data analysis or a decision support. We developed a system that generates structured reports for chest x-ray radiography. Based on analyzing existing reports, we determined the fundamental sentence structure of findings as compositions of procedure, region, finding, and diagnosis. We categorized the observation objects into lung, mediastinum, bone, soft tissue, and pleura and chest wall. The terms of region, finding, and diagnosis were associated with each other. We expressed the terms and the relations between the terms using a resource description framework (RDF) and developed a reporting system based on it. The system shows a list of terms in each category, and modifiers can be entered using templates that are linked to each term. This system guides users to select terms by highlighting associated terms. Fifty chest x-rays with abnormal findings were interpreted by five radiologists and reports were made either by the system or by the free-text method. The system decreased the time needed to make a report by 12.5% compared with the free-text method, and the sentences generated by the system were well concordant with those made by free-text method (F-measure = 90%). The results of the questionnaire showed that our system is applicable to radiology reports of chest x-rays in daily clinical practice. The method of generating structured reports for chest x-rays was feasible, because it generated almost concordant reports in shorter time compared with the free-text method.

Tuberculosis In A Nigerian Medium Security Prison

Introduction: Prisons worldwide have been cited as reservoirs for tuberculosis and also an ideal setting for interventions but little is known about the epidemiology and control of tuberculosis in Nigerian Prisons. Objective: To determine the prevalence of tuberculosis, role of prison in its control and the mortality from tuberculosis among prison inmate in Kuje prison, Abuja, Nigeria. Materials and Methods: This study was a retrospective study of cases of tuberculosis in Kuje prison between April, 2004 and December, 2008. Data was collected from their medical records. The inclusion criterion was: (1) Cases of tuberculosis in which the diagnosis was based on clinical history, smear positive test and chest x-ray radiograph. (2) Cases where the treatment of tuberculosis was according to treatment strategy recommended by World Health Organization. Results: A total of forty-eight inmates, aged 20 to 45years, were diagnosed with tuberculosis within the period of interest. The prevalence rate was 2.4%, based on a total prison population of 2002. Majority of cases 93.8% were first detected in Prison and the remaining 6.3% were detected prior to incarceration. Out of the 6.3% diagnosed prior to incarceration, 2.1% and 4.2% of cases have defaulted from DOTS for 2weeks and more than 4weeks respectively. Majority (66.7%) completed the treatment before discharging from prison, 29.2% were discharged from prison at various level of treatment and 4.2% of cases died while on reatment. Those who died were co-infected with HIV Conclusion: It was evident from this study that: The prevalence of tuberculosis in Kuje prison was high, prison has a role in diagnosis and treatment, adherence and treatment outcome were good and the main indicator for mortality was HIV infection. Primary prevention measures specifically targeting prisoners are needed to reduce prevalence of tuberculosis and also to achieve the objectives of National Health Policy on tuberculosis and leprosy. Keywords: Prison, tuberculosis, control, mortality

Ability of chest X-ray to detect faint shadows documented as ground-glass attenuation in images of computed tomography: A comparison between flat-panel detector radiography and film-screen radiography

Purpose To compare flat-panel detector (FPD) radiography and film-screen (FS) radiography in detectability of faint shadows documented as ground-glass attenuation (GGA) areas in images of computed tomography (CT). Materials and methods Study population was comprised of 50 patients who underwent FS and another 50 patients who underwent FPD. Standard of reference (SOR) was determined on the basis of area of GGA in all cross-sections of CT, in terms of GGA extent and presence or absence of GGA in each trisected lung fields (GGA distribution). Eight radiologists assessed the GGA extent with the 5-grade scale and the GGA distribution. Inter-observer variances of the GGA extents and distributions, degree of divergences and correspondence in the GGA extent and distributions with SOR, were compared between the FS and FPD by the jackknife method and Fisher's exact test. Results Inter-observer variance in the GGA extent and distribution were slightly larger in the FS than in the FPD. The GGA extent scale corresponded with SOR in the FS statistically significantly better ( p = 0.001), as the correct ratio was 0.428 in the FS and 0.310 in the FPD. Divergence in the GGA extent scale with SOR was smaller in the FS, as average kappa pseudo-value of Kendall's rank correlation coefficient was 0.474 in the FS and 0.433 in the FPD. Conclusion These results indicate that some lesions of GGA documented in CT may not be reflected and are difficult to be detected in chest X-ray radiographs with the FPD.

Imaging of cardiovascular malformations in Williams syndrome

Objective To evaluate the imaging methods for cardiovascular malformations in Williams syndrome(WS).Methods Thirteen cases of WS(7 males and 6 females)aged 10 months to 13 years were involved in this study.All patients underwent chest X-ray radiography,electrocardiography.echocardiography and physical examination.3 cases underwent electronic beam computed tomography (EBCT),cardiac catheterization and angiography were performed in 8 cases.Results Twelve patients were referred to our hespital for cardiac murmur and 1 cnse for cyanosis after birth.7 patients were found with elfin-likefacial features.6 patients with pulmonary arterial stenosis.2 Cases with patent ductus arteriosus.2 case8 with 8evere pulmonary hypertension and 1 case with total endocardial cushion defect.Sudden death occurred in 2 patients during and after catlleterization.respectively. Conclusions Conventional angiography is the golden standard for the diagnosis of cardiovascular malformations in WS.Noninvnsive methods such as MSCT and MRI should be suggested because of the risk of sudden death in conventional angiography. Key words: Williams syndrome; Cardiovascular abnormalities; Diagnostic imaging; Death,sudden

Quantitative Kinetic Analysis of Lung Nodules Using the Temporal Subtraction Technique in Dynamic Chest Radiographies Performed with a Flat Panel Detector

Early detection and treatment of lung cancer is one of the most effective means of reducing cancer mortality, and to this end, chest X-ray radiography has been widely used as a screening method. A related technique based on the development of computer analysis and a flat panel detector (FPD) has enabled the functional evaluation of respiratory kinetics in the chest and is expected to be introduced into clinical practice in the near future. In this study, we developed a computer analysis algorithm to detect lung nodules and to evaluate quantitative kinetics. Breathing chest radiographs obtained by modified FPD and breath synchronization utilizing diaphragmatic analysis of vector movement were converted into four static images by sequential temporal subtraction processing, morphological enhancement processing, kinetic visualization processing, and lung region detection processing. An artificial neural network analyzed these density patterns to detect the true nodules and draw their kinetic tracks. Both the algorithm performance and the evaluation of clinical effectiveness of seven normal patients and simulated nodules showed sufficient detecting capability and kinetic imaging function without significant differences. Our technique can quantitatively evaluate the kinetic range of nodules and is effective in detecting a nodule on a breathing chest radiograph. Moreover, the application of this technique is expected to extend computer-aided diagnosis systems and facilitate the development of an automatic planning system for radiation therapy.

Smoking, smoking cessation and aortic arch calcification in older Chinese: The Guangzhou Biobank Cohort Study

Objective To study the association between smoking, smoking cessation and aortic arc calcification (AAC) in an older Chinese population. Methods A total of 3022 men and 7279 women aged 50–85 years were recruited and received a medical check-up including measurement of fasting plasma vascular risk factors. Two radiologists reviewed the posterior–anterior plain chest X-ray radiographs and assessed AAC together. Information on smoking status, socioeconomic and lifestyle factors was collected. Results The crude prevalence of AAC in men (38.58%) was lower than that in women (41.37%). The adjusted odds ratios of AAC increased significantly across never, ex- and current smokers in both genders. Dose–response relationships were observed among current smokers for smoking amount (cigarettes/day), smoking duration (years) and cigarette pack-years in both genders (all p < 0.01). The odds ratios decreased significantly ( p = 0.018) with longer duration of quitting in light ex-smoking men (<23.5 pack-years) but showed no beneficial effect ( p = 0.72) for heavy ex-smokers (≥23.5 pack-years). Conclusion Smoking increased the risk of AAC in Chinese, while smoking cessation decreased the risk only in male light ex-smokers. Chest X-ray is a cheap and simple method to detect AAC, which should be an important warning signal for immediate smoking cessation.

Case Report: A Patient with Haemorrhagic Bleeding, an Acquired Factor VIII Inhibitor and Massive Pulmonary Embolism.

A female, 48-year old patient was referred to an emergency ward with dyspnoea, haemoptysis and suspected respiratory infection that had been refractory to prior antimicrobial therapy. The onset of dyspnoea dated back to a febrile episode three months prior to presentation. The patient continued to work in spite of severe shortness of breath. Her history revealed a cervical cancer which had been treated by neoadjuvant radiochemotherapy and extended hysterectomy in 2005. Upon admission, extensive spontaneous haematomas were noted on the upper extremities. Following a diagnostic puncture of the radial artery, severe haemorrhage and compartmentalization developed, and the patient was transferred to our hospital for a surgical emergency intervention and haemostaseological counselling. A decreased factor VIII activity was noted, with a prolonged partial thromboplastin time, a normal von Willebrand Factor activity and concentration, a prolonged bleeding time and a low-titer inhibitor to factor VIII. Additionally, a profound hyponatremia (117 mmol/l) awaited explanation. Haemorrhage was treated with recombinant Factor VIIa, allowing for a successful surgical de-compartmentalization. With regard to the consistent feature of dyspnoea and partial respiratory insufficiency, bronchoscopic examination revealed only minor hemorrhagic suffusion of the bronchial epithelium, but no sign of infection or major pulmonary bleeding. Chest X-ray and laboratory findings showed right ventricular enlargement, bilateral infiltrates and an excessively high NT-pro-BNP concentration in plasma (13027 ng/l). Chest X-ray radiographs performed two months previously for suspected respiratory infection showed pulmonary infiltrates of comparable size, albeit no right ventricular enlargement. Computerized tomography of the chest showed a complete obstruction of the right pulmonary artery and of the lower branch of the left pulmonary artery. Pulmonary arterial pressure was measured at 70 mm Hg. Immunosuppressive therapy was initiated, with concomitant aPTT-adjusted anticoagulation. Upon clinical deterioration with right-ventricular failure, a catheter-based disruption of the emboli was attempted, albeit with no success. A cardio-surgical intervention with thrombendectomy was performed successfully; however, the patient succumbed to sepsis and multiorgan failure ten days later. The autopsy revealed multiple thrombi, a bilateral pulmonary haemorrhagic infarction and a disseminated lymphangiosis and hemangiosis carcinomatosa of the lungs. We conclude that the acquired inhibitor to factor VIII was of paraneoplastic origin and, although detected at a low titre, clinically relevant. Based on previous radiographic findings, a massive pulmonary embolism must be assumed to have occurred months prior to presentation. The anticoagulatory effect of the acquired inhibitor to Factor VIII may have averted the timely detection of the pulmonary embolism.

Multislice helical CT and chest radiographic findings in congenital bronchial atresia

目的 分析先天性支气管闭锁的CT和X线表现,以提高对该病的认识和诊断.方法对11例支气管闭锁患者进行了多层螺旋CT(MSCT)扫描.其中3例经手术证实,6例有支气管镜结果,2例随诊1年以上.肺部常规10 mm层厚扫描,在16层螺旋CT机进行1.25 mm后处理重组,获得多平面重建(MPR)、最大密度投影(MIP)和最小密度投影(MinIP)图像,记录病变的部位和周围肺组织改变. 结果 11例病变CT均能显示黏液栓和周围气肿改变,其中3例黏液栓内含气体;X线平片亦能显示全部黏液栓,但仅显示8例气肿改变和2例黏液栓内的气液平.3例支气管闭锁位于左侧,8例位于右侧;发生于段支气管者10例,亚段1例;6例位于肺门旁,5例远离肺门.结论黏液栓和周围肺气肿改变是先天性支气管闭锁的典型表现,在先天性支气管闭锁诊断和鉴别诊断上,多层面螺旋CT 能提供比X线平片更多的信息。

Occult pneumothorax in trauma patients: Should this be sought in the focused assessment with sonography for trauma examination?

At present, CT scan is the gold standard for detecting occult traumatic pneumothorax not apparent on supine chest X-ray radiograph. Recently there were suggestions to expand focused assessment with sonography for trauma (FAST) to include thoracic ultrasound for detecting pneumothorax. The aim of the present study is to determine the incidence of occult pneumothorax (as shown by CT) in the subgroup of trauma patients undergoing FAST. Review of all trauma patients with FAST done from 1 June 2001 to 31 October 2002. Incidence of occult pneumothorax as diagnosed by CT was determined. Patients were not counted as having true occult pneumothorax if they had chest drains inserted before arrival or imaging studies. Selected clinical findings were tested for association with occult pneumothorax. In total, 143 patients underwent FAST, of whom 137 (95.8%) had chest X-ray examination performed. Of the 137 patients 59 required CT abdomen and/or thorax. Occult pneumothorax was found in three patients (2.1%). A history of thorax and/or abdominal injury plus one or more of: (i) mechanisms potentially causing major trauma; (ii) abnormal chest examination; and (iii) chest X-ray radiograph abnormality in the absence of pneumothorax, was significantly associated with the presence of occult pneumothorax (P = 0.03, Fisher's exact test; sensitivity: 100%; specificity: 71%; likelihood ratio: 3.42). The incidence of occult pneumothorax in the subgroup of trauma patients undergoing FAST is low. It implies that routine screening for its presence by adding thoracic ultrasound to FAST is unnecessary. Identifying those at risk of occult pneumothorax for further investigation appeared feasible.

脊椎手術後に発症した冠動脈狭窄の２例

Ishemic heart disease including myocardial infarction is one of the most serious perioperative complications. We experienced two cases of ischemic heart disease due to abrupt arrhythmia after spinal surgery. One case showed ventricular fibrillation soon after surgery and the other showed atrial premature contraction two days after surgery on electrocardiogram. Although they did not present any abnormal findings on routine preoperative examinations (chest x-ray radiograph, electrocardiogram, and echocardiogram), constriction of the coronary artery was indicated by postoperative angiography. They were treated by coronary artery bypass graft and completely recovered without after-effects.Patients with spinal disorders seldom display symptoms of myocardial ischemia because of reduced daily activities in terms of motor dysfunction. On the other hand, positional changes under unstable cardiovascular dynamics during surgery may have possibility to induce the ischemic responses of heart muscles. In other words, it is extremely difficult to make the accurate diagnosis of myocardial ischemia preoperatively and is critical once it occurrs.We should bear in mind that asymptomatic myocardial ischemic patients who do not show any abnormal findings in usual preoperative screening do exist when attempting spinal surgery.

Routine radiography does not have a role in the diagnostic evaluation of ambulatory adult febrile neutropenic cancer patients

Cancer patients treated with chemotherapy are susceptible to bacterial infections. When an adult patient presents with febrile neutropenia, standard diagnostic care includes physical examination, laboratory diagnostics, chest X-ray (CXR) and sinus radiography. However, the yield of routine radiography in the diagnostic evaluation of ambulatory adult febrile neutropenic patients with normal findings at their physical examination is questionable. Two CXRs and one sinus X-ray were obtained in 109 and 106 febrile neutropenic episodes after chemotherapy in ambulatory adult patients who had no clinical signs suggesting pulmonary infection or sinusitis. We found that in only two of 109 (1.8%; 95% Confidence Interval (CI): 0.3–5.8%) febrile neutropenic episodes without clinical signs of new pulmonary disease, the CXR showed a consolidation suggesting pneumonia. In addition, in five of 88 (5.7%; 95% CI: 2.2–12.0%) febrile episodes in asymptomatic patients, sinus X-ray suggested sinusitis. In none of these seven episodes was a change of antibiotic therapy necessary. In the absence of clinical signs indicating pneumonia or sinusitis, the yield of CXR and sinus radiography in ambulatory adult cancer patients presenting with febrile neutropenia is minimal; CXR and sinus radiography should no longer be performed on a routine basis.

Laparoscopic antireflux surgery for supraesophageal complications of gastroesophageal reflux disease

Gastroesophageal reflux disease can result in such supraesophageal complications as hoarseness, sore throat, cough, bronchitis, asthma, recurrent pneumonia, intermittent choking, chest pain, and ear pain. Appropriate patient care involves careful evaluation to decide on medical or surgical therapy. Preoperative testing must include endoscopy, 24-hour esophageal pH monitoring, and esophageal manometry. Additional evaluations, such as barium swallow, chest x-ray, bronchoscopy, and sinus radiographs, may be required. Medical treatment improves gastroesophageal reflux and supraesophageal symptoms. However, surgical therapy seems to provide better long-term results. A profile that predicts the best response to medical therapy has not been identified, although the best results with surgery are achieved in patients with nocturnal asthma, onset of reflux before pulmonary symptoms, laryngeal inflammation, and a good response to medical treatment.

289 胸部X線撮影時の生殖腺防護について

289 胸部X線撮影時の生殖腺防護について

A lung ung cancer model based on intrapulmonary implantation of tumour material

A lung cancer model based on implantation of tumour fragments in the posterior lobe of the right lung of WAG/Rij rats by a surgical procedure has been developed. Two transplantable squamous cell carcinomas which were induced by implanted iridium-192 wires in the lung, were used in this study. The characteristics of these tumours following intrapulmonary implantation are reported with respect to growth rate, invasiveness and metastasizing capacity. The tumour volumes are determined by X-ray chest radiographs. Mean tumour volume doubling times are about 9 days. This system provides a means to evaluate treatment regimens involving irradiation and chemotherapeutic drugs.