Initial Chest Radiograph Research Articles

Presenting hydrothorax predicts failure of needle aspiration in primary spontaneous pneumothorax

ObjectiveThe objective was to evaluate if existence of hydrothorax in initial chest radiograph predicts treatment outcome in patients with primary spontaneous pneumothorax who received needle thoracostomy. MethodsThis is a retrospective cohort study carried out from January 2011 to August 2014 in 1 public hospital in Hong Kong. All consecutive adult patients aged 18years or above who attended the emergency department with the diagnosis of primary spontaneous pneumothorax with needle aspiration performed as primary treatment were included. Age, smoking status, size of pneumothorax, previous history of pneumothorax, aspirated gas volume and presence of hydropneumothorax in initial radiograph were included in the analysis. The outcome was success or failure of the needle aspiration. Logistic regression was used to identify the predicting factors of failure of needle aspiration. ResultThere were a total of 127 patients included. Seventy-three patients (57.5%) were successfully treated with no recurrence upon discharge. Among 54 failure cases, 13 patients (10.2%) failed immediately after procedure as evident by chest radiograph and required second treatment. Forty-one patients (32.3%) failed upon subsequent chest radiographs. Multivariate logistic regression showed factors independently associated with the failure of needle aspiration, which included hydropneumothorax in the initial radiograph (odds ratio [OR]=4.47 [1.56i12.83], P=.005), previous history of pneumothorax (OR=3.92 [1.57-9.79], P=.003), and large size of pneumothorax defined as apex-to-cupola distance ≥5cm (OR=2.75 [1.21-6.26], P=.016). ConclusionsHydropneumothorax, previous history of pneumothorax, and large size were independent predictors of failure of needle aspiration in treatment of primary spontaneous pneumothorax.

Factors associated with extended treatment among tuberculosis patients at risk of relapse in California.

California, United States. To determine the frequency of tuberculosis (TB) patients at risk for relapse who received at least 9 months of anti-tuberculosis treatment (extended treatment) and to identify factors associated with not receiving extended treatment. We analyzed characteristics of culture-confirmed pulmonary TB patients reported to the California TB Registry during 2004-2009. Patients with cavities on initial chest radiograph and delayed culture conversion (⩾70 days) were at 'high risk of relapse', and anti-tuberculosis treatment of ⩾270 days was 'extended treatment'. We used a generalized linear model to identify independent risk factors for absence of extended treatment in the high risk of relapse group. Among 5680 TB patients, 483 (8.5%) were at high risk of relapse: 372 (77%) received extended treatment but 111 (23%) did not. Factors associated with absence of extended treatment included negative sputum smears (adjusted prevalence ratio [aPR] 2.62, 95%CI 1.69-4.05), residence in three specific counties (aPR 1.71, 95%CI 1.19-2.46) and Black race (aPR 1.56, 95%CI 1.03-2.38). Nearly a quarter of TB patients at high risk of relapse did not receive extended treatment. Increased efforts are needed to ensure that all patients who may benefit from extended anti-tuberculosis treatment receive it.

The usefulness of low-dose CT scan in elderly patients with suspected acute lower respiratory infection in the emergency room.

To evaluate the usefulness of low-dose CT (LDCT) for the diagnosis of acute lower respiratory infection (ALRI) in elderly patients in the emergency room (ER). A total of 160 consecutive patients (mean age: 75.9 ± 9.2 years; range: 60-97 years), who were diagnosed to have ALRI by LDCT in the ER, were enrolled in this study. Initial chest radiograph (CR) and CT patterns of ALRI were analysed, and clinical courses of patients were assessed. 49 patients showed negative CR, in whom the main CT patterns were diffuse bronchial wall thickening (n = 23), ground-glass opacity (n = 6), mixed centrilobular nodules and ground-glass opacity (n = 3), small consolidation (n = 8) or consolidation in the dependent lung (n = 9), while the other 111 patients with the main CT pattern of consolidation demonstrated pulmonary abnormality on CR. Pulmonary oedema (12.5%) and pleural effusion (23.1%) were associated. The rate of hospitalization, care in the intensive care unit, mortality and comorbidity were significantly higher in the CR(+)LDCT(+) group (88.3%, 36.1%, 18.2% and 59.5%) than in the CR(-)LDCT(+) group (55.1%, 8.2%, 2.0% and 38.8%; p ≤ 0.05). LDCT was useful for the early diagnosis of ALRI in elderly patients who showed negative initial CR. The patients with negative initial CR had main CT patterns of diffuse bronchial wall thickening, ground-glass opacity, centrilobular nodules, small consolidation or consolidation in the dependent lung on LDCT. The use of LDCT may be considered for the early diagnosis of ALRI in elderly patients who have high comorbidity.

Bilateral Anterior Shoulder Dislocations due to Seizure

Volume 2 • Issue 1 • 1000160 Trop Med Surg ISSN: 2329-9088 TPMS, an open access journal A 33 year-old man presented to the emergency department (ED) after intentional overdose of prescription drugs with concomitant cocaine and alcohol abuse. During assessment, he had a witnessed generalized tonic-clonic seizure that terminated after intravenous lorazepam administration. He was admitted to the Intermediate Care Unit for ongoing close monitoring due to persistently altered mental status. When more alert the following day he complained of bilateral shoulder pain with markedly restricted range of movement. An initial screening chest radiograph demonstrated bilateral anterior shoulder dislocations with an associated fracture of the left greater tuberosity (Figure 1). On further discussion a history of multiple bilateral shoulder dislocations with minimal force was elicited. He was reviewed by the orthopedic service that elected to perform closed reduction under general anesthesia and he was placed in bilateral shoulder immobilizers for 2 weeks. Operative repair was recommended.

Paraquat tongue: rebirth of paraquat intoxication

The World Health Organization (WHO) acknowledges that acute pesticide poisoning account for significant morbidity and mortality worldwide, especially in developing countries. We presented an interesting case of paraquat intoxication.A 39-year-old man was brought to our emergency department (ED) by his family soon after attempting suicide by ingesting unknown substances. Initial vital signs, laboratory data, and chest radiography showed normal. Only green-blue color of finger and redness of tongue were noted. Initial urine paraquat test (qualitative) was also negative at our ED. We still arranged hemoperfusion therapy due to the strong contact history and some physical examination findings. Finally, the serum paraquat level at ED was 0.1 μg/ml. This case highlights that even in cases with negative urine paraquat tests, detailed history taking and physical examination can help the diagnosis of paraquat poisoning. Early recognition and the appropriate treatment are imperative.

Case 224: Cardiac Involvement in Erdheim-Chester Disease.

History A 61-year-old man with no relevant medical history was admitted to the emergency department with symptoms of congestive heart failure and a 1-week history of chest pain, progressive dyspnea, abdominal swelling, bipedal edema, and anorexia. Laboratory test results, including complete blood count and electrolyte, creatinine, creatine phosphokinase, and troponin T levels were normal. Electrocardiographic findings were unremarkable. Initial chest radiography showed an enlarged heart with bilateral pleural effusion. Transthoracic echocardiography revealed an irregular right atrial mass and moderate to severe pericardial effusion. The patient subsequently underwent computed tomography (CT) of the chest, abdomen, and pelvis followed by cardiac magnetic resonance (MR) imaging for further evaluation of the atrial mass. Because of the suspected diagnosis, conventional radiography of the skeleton was performed.

A Case of Lipoid Pneumonia From Mineral Oil Aspiration With Delayed-Onset ARDS

SESSION TITLE: Lung Pathology Student/Resident Case Report Posters SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM INTRODUCTION: Hydrocarbons may facilitate aspiration via inhibition of the cough reflex. Very few observational studies have been performed to investigate the evolution and outcomes of hydrocarbon aspiration. CASE PRESENTATION: A 17-month-old boy presented to a local Emergency Department with signs of respiratory distress and concern for aspiration of baby oil. Initial chest radiograph showed bilateral perihilar and lower lobe infiltrates and antibiotic therapy was initiated. Within 24 hours of aspiration, the patient developed tachypnea and hypoxia with confirmed radiographic evolution of infiltrates. He was initiated on oxygen therapy and antibiotic coverage was broadened to treat lipoid aspiration pneumonia with superimposed bacterial pneumonia. In spite of combined therapy with antimicrobials and systemic steroids, he continued to be hypoxemic and ultimately required invasive ventilatory support for respiratory embarrassment. Initial bronchoalveolar lavage performed two weeks into his course showed opaque fluid with numerous inflammatory cells. Following his second therapeutic bronchoalveolar lavage, the patient was extubated and discharged home on supplemental oxygen therapy. DISCUSSION: This rare case depicts delayed-onset acute respiratory distress syndrome secondary to evolution of injury from hydrocarbon inhalation. The performance of multiple bronchoalveolar lavages within months of suspected aspiration has been shown to improve clinical outcomes and radiographic disease amongst children with lipoid aspiration. In our case, steroids may have decreased inflammation, but did not prevent lung injury. CONCLUSIONS: Very few observational studies have been performed describing the natural history of lipoid aspiration pneumonia, particularly among children. Most clinical outcomes are favorable, as in the case of our patient, but some children will develop pulmonary fibrosis. The utility of steroids remains controversial and warrants further investigation. This case emphasizes the importance of conversations regarding household safety at preventive health visits. Reference #1: Marchiori, E., Zanetti, G., Mano, C.M., Hochhegger, B. “Exogenous lipoid pneumonia. Clinical and radiological manifestations.” Respiratory Medicine. 2011. 105, 659-666. Reference #2: de Azevedo Sias, S.M., Ferreira, A.S., Daltro, P.A., Caetano, R.L., da Silva Moreira, J., Quirico-Santos, T. “Evolution of exogenous lipoid pneumonia in children: clinical aspects, radiological aspects and the role of bronchoalveolar lavage.” J Bras Pneumol. 2009. 35(9): 839-845. Reference #3: Sias, S.M.A, Daltro, P.A., Marchiori, E., Ferreira, A.S., Caetano, R.L., Silva, C.S., Muller, N.L., Moreira, J., Quirico-Santo, T. “Clinic and Radiological Improvement of Lipoid Pneumonia With Multiple Bronchoalveolar Lavages.” Pediatric Pulmonology. 2009. 44, 309-315. DISCLOSURE: The following authors have nothing to disclose: Ashley Devonshire, Sonal Malhotra, Mary Nevin No Product/Research Disclosure Information

Clinical Outcomes in Cardiac Arrest Patients Following Prehospital Treatment with Therapeutic Hypothermia.

Recent studies have brought to question the efficacy of the use of prehospital therapeutic hypothermia for victims of out-of-hospital cardiac arrest (OHCA). Though guidelines recommend therapeutic hypothermia as a critical link in the chain of survival, the safety of this intervention, with the possibility of minimal treatment benefit, becomes important. Hypothesis/Problem This study examined prehospital therapeutic hypothermia for OHCA, its association with survival, and its complication profile in a large, metropolitan, fire-based Emergency Medical Services (EMS) system, where bystander cardiopulmonary resuscitation (CPR) and post-arrest care are in the process of being optimized. This evaluation was a retrospective chart review of all OHCA patients with return of spontaneous circulation (ROSC) treated with therapeutic hypothermia, from January 1, 2013 through November 30, 2013. The primary outcomes were the proportion of patients with initiation of prehospital therapeutic hypothermia with survival to hospital admission, the proportion of patients with initiation of prehospital therapeutic hypothermia with survival to hospital discharge, and the complication profile of therapeutic hypothermia in this population. The complication profile included several clinical, radiographic, and laboratory parameters. Exclusion criteria included: no prehospital therapeutic hypothermia initiation; no ROSC; and age of 17 year old or younger. Fifty-one post-cardiac arrest patients were identified that met inclusion criteria. The mean age was 61 years (SD=14.7 years), and 33 (72%) were male. The initial rhythm was ventricular fibrillation or pulseless ventricular tachycardia in 17 (37%) patients, and bystander CPR was performed in 28 (61%) patients with ROSC. Thirty-nine (85%) patients survived to hospital admission. Twenty-one patients (48%; 95% CI, 33-64) were administered vasopressors, 10 patients (24%; 95% CI, 10-37) were administered diuretics, and 19 patients (44%; 95% CI, 29-60) were administered antibiotics. Initial chest radiograph (CXR) findings were normal in 12 (29%) patients. Overall, 13 (28%; 95% CI, 15-42) study patients survived to hospital discharge. Recent reports have questioned the efficacy and safety of prehospital therapeutic hypothermia. In this evaluation, in the setting of unstandardized post-arrest care, 85% of the patients survived to hospital admission and 28% survived to hospital discharge, with a complication profile which was similar to that noted in other studies. This suggests that further evidence may be needed before EMS systems stop administering therapeutic hypothermia to appropriately selected patients. In less-optimized systems, therapeutic hypothermia may still be an essential link in the chain of survival.

The Findings on Initial Admission Chest Radiograph of Patients Presenting with an Acute Exacerbation of COPD – A South African Study

AbstractIntroduction: Despite the recognition that infections (including both viral and/or bacterial) play an important role in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) there have been relatively few studies documenting the radiological changes in patients hospitalized with an AECOPD, which was the aim of the current study.Methods: This was a retrospective record review of consecutive hospitalized cases admitted to the Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa, between June 2011 and February 2013, in whom an admission chest radiograph was available for review.Results: Overall 34 patients were entered into the study. Evidence of hyperinflation was documented in 29 of 33 cases (87.9%). In 2 cases hyperinflation was the only radiological finding. Additional abnormalities noted on the chest radiographs (sometimes multiple) were as follows: parenchymal changes in 24, interstitial changes in 4, and pleural changes in 8 cases. Eleven patients (33%) h...

Pneumomediastinum: Can we tell prognosis upon presentation?

AimPneumomediastinum is an uncommon condition with differential diagnoses of very different prognosis. The aim of the present study was to retrospectively review patients who presented with pneumomediastinum, and to look for salient features on presentation to establish the difference between benign spontaneous pneumomediastinum (SPM) and oesophageal perforation (Boerhaave's syndrome) on presentation.Patients and MethodsFrom 1 July 1999 to 30 June 2013, 163 cases of pneumomediastinum, excluding those with trauma and procedure‐related episodes, presented through the Accident and Emergency Department to the Hospital Authority hospitals in the New Territories East Cluster. There were 142 SPM cases, and 21 were oesophageal perforations.ResultsPresenting features, hospital stay and outcomes were analysed. Fever at presentation (P = 0.030), history of vomiting (P = 0.028), pneumothorax on initial chest radiograph (CXR) (P = 0.044) and age ≥ 28 years (P = 0.021) were found to be independent predictors for non‐SPM diagnoses.ConclusionSPM is still more common than oesophageal perforation in those without any history of trauma or recent instrumentation, and runs a benign course. However, the presence of fever, a history of vomiting, pneumothorax on initial CXR and patient age over 28 years should mandate further investigations to rule out more sinister diagnoses and to administer appropriate management.

Elderly Woman With Shortness of Breath

An 80-year-old woman of Eastern European descent presented to our institution with a history of worsening shortness of breath, wheezing, and cough. She required supplementary oxygen to correct hypoxia. Initial chest radiograph result was unremarkable, and a pulmonary ventilation-perfusion scan was performed to exclude a pulmonary embolus (Figure 1). She proceeded to contrast-enhanced computed tomography (CT) and bronchoscopy (Figures 2 and 3).

Survival following massive amitriptyline overdose: The use of intravenous lipid emulsion therapy and the occurrence of acute respiratory distress

While survival has been reported after ingestion of 4.25 g amitriptyline, for which intravenous lipid emulsion (ILE) therapy was administered, we recently managed a patient who made a full recovery after a 4.8 g amitriptyline overdose. Interesting features of the case were a marked response to ILE and the subsequent development of acute respiratory distress syndrome (ARDS). Our patient had taken 96 amitriptyline 50mg tablets (total 4.8 g or 80mg/kg), an uncertain amount of zopiclone, alcohol and venlafaxine. In the emergency department the patient was hypotensive and unresponsive (GCS 3), with a prolonged QTc identified on ECG. Rapid sequence induction was performed followed by transfer to the intensive care unit for full supportive therapy. Further management and key parameters are illustrated in Figure 1. Hypotension was unresponsive to fluid therapy, and noradrenaline therapy was required. Intravenous bicarbonate therapy and mild hyperventilation (with tidal volumes 6ml/kg) were utilised, aiming to achieve a pH of 7.55. Three grand mal seizures occurred which were treated with a midazolam bolus followed by an infusion. Approximately 12 h after the drug ingestion, with escalating noradrenaline requirements, ILE was administered. The subsequent improvement in blood pressure and reduction in noradrenaline can be seen in Figure 1. Case reports detailing the successful use of ILE for the treatment of toxicity of lipophilic drugs including tricyclic antidepressants are well documented. A recent prospective, randomised, controlled trial found no benefit of ILE compared to bicarbonate in a pig model of amitriptyline toxicity. A rabbit model found conflicting results. Various mechanisms have been suggested for the mechanism of action of ILE, but the lipid sink hypothesis describes how ILE may provide a large binding site for the drug, removing it from effective circulation. Given the pKa of amitriptyline of 9.4, prior alkalinisation, as was undertaken in this case, might be expected to augment the effect of ILE by decreasing the ionised portion of the drug. On day 3 of their care, our patient developed criteria of ARDS with a PaO2/FiO2 ratio of 70mmHg by day 5. Proning was required, tracheostomy was performed and a prolonged respiratory wean ensued with 40 days of invasive ventilation. There was no evidence of pulmonary aspiration at the scene of the overdose, during intubation or on the initial chest radiograph, though micro-aspiration cannot be excluded. Ultimately, Streptococcus pneumonia and mixed coliforms were grown from bronchoalveolar lavage of the patient’s lungs; however, concern was raised that ILE could have been linked to the ARDS. The patients subsequently made a full physical recovery. Acute respiratory distress syndrome has been reported in three patients in a case series of nine patients treated with ILE but, as the authors acknowledge, critically ill patients are at risk of ARDS. Furthermore, ARDS has been reported as a complication of tricyclic overdose. Nonetheless, case series into the use of lipid infusion in ARDS and septicaemia have linked it to worsening oxygenation. We believe this to be one of the highest reported overdoses of amitriptyline that has been survived and that the use of ILE contributed to this outcome. Our experience demonstrates the potential use of ILE outside the setting of cardiac arrest or cardiovascular collapse but highlights concerns regarding its potential association with ARDS.

The Effectiveness of Chest Radiographic Screening Among Tuberculosis Contacts

For decades, the most important strategy in tuberculosis (TB) control in Taiwan is to find case early and provide treatment to patient in a timely manner. In order to detect a case in a timely way, finding active TB cases amongst populations with poor access to medical care has been found to be especially important. Due to the implementation of various strategies, the number of infectious TB patients in Taiwan has decreased yearly, in a gradual fashion. The strategy of active case finding (ACF) has been adjusted step by step. Review from literature, an enhanced ACF effort for a TB contact is the best way to decrease the persistent transmission of TB from both an empirical and cost-benefit point of view. Our study enrolled the contacts of TB patients diagnosed from April 1, 2008 to December 31, 2012. Every contact had at least completed an initial chest radiograph (CXR) for the purpose of contact tracing. The rate of newly developed TB among contacts was further analyzed with stratifications of infectious TB index patients and birth cohorts of contacts. The effectiveness of both first and 12th month CXR screening was evaluated respectively. The results showed that the first CXR screening among contacts was helpful for ACF. The detection rate of TB after the first CXR performed on the contacts, whose index TB patient had extra-pulmonary TB without lung involvement, was found to be low enough that CXR service could be suspended for this target population if radiographic resources were strained at some point in the future. However, contact screening for target population younger than 5 years was still essential. As to the 12th month CXR among contacts, the detection rate was acceptable only when index TB patients were smear-positive and culture confirmed as Mycobacterium tuberculosis. For contacts whose index TB patients were classified as infectious, those who took 12th month CXR examination could be diagnosed 2 months earlier compared with those who did not complete 12th month CXR examination.

Treatment of Drug Susceptible Pulmonary Tuberculosis.

Tuberculosis (TB) remains a major global health problem, and the incidence of TB cases has not significantly decreased over the past decade in Korea. The standard short course regimen is highly effective against TB, but requires multiple TB-specific drugs and a long treatment duration. Recent studies using late-generation fluoroquinolones and/or high-dose rifapentine-containing regimens to shorten the duration of TB treatment showed negative results. Extending the treatment duration may be considered in patients with cavitation on the initial chest radiograph and positivity in sputum culture at 2 months of treatment for preventing TB relapse. Current evidence does not support the use of fixed-dose combinations compared to separate drugs for the purpose of improving treatment outcomes. All patients receiving TB treatment should be monitored regularly for response to therapy, facilitation of treatment completion, and management of adverse drug reactions. Mild adverse effects can be managed with symptomatic therapy and changing the timing of the drug administration, but severe adverse effects require a discontinuation of the offending drugs.

A 40-Year-Old Woman With Multiple Pulmonary Nodules

A 40-year-old woman (a nonsmoker) with history of idiopathic thrombocytopenic purpura and a platelet count > 90,000 cells/μL without specific medication was referred to pulmonary clinic for evaluation of multiple pulmonary nodules. The patient presented to an outside hospital with fatigue, lack of energy, and dyspnea on exertion for 2 years. She denied fever, cough, chest pain, or weight loss. An initial chest radiograph showed bilateral multiple pulmonary nodules. A chest CT scan revealed multiple nodular lesions, varying in size, in all lobes of both lungs. There was no mediastinal lymphadenopathy or pleural effusion. There was no significant hypermetabolic activity on a subsequent fluorodeoxyglucose PET scan/CT scan, and there had been no significant change. She underwent CT scan-guided percutaneous transthoracic biopsy and bronchoscopy with transbronchial biopsies, all of which were inconclusive. An open lung biopsy was considered.

Usefulness of Digital Tomosynthesis for the Detection of Airway Obstruction: A Case Report of Bronchial Carcinosarcoma.

Bronchial carcinosarcoma is a very rare malignant tumor that is composed of carcinomatous and sarcomatous elements. We describe the first case in which digital tomosynthesis was useful for the evaluation of airway obstruction by bronchial carcinosarcoma that was overlooked on initial chest radiography.

Early radiologic evidence of severe respiratory distress syndrome as a predictor of nasal continuous positive airway pressure failure in extremely low birth weight newborns.

To determine whether early radiologic evidence of severe respiratory distress syndrome (RDS) is predictive of nasal continuous positive airway pressure (CPAP) failure in extremely low birth weight (ELBW) infants during the first 72 h of age. Retrospective analysis of 235 consecutively inborn ELBW infants who received initial support with CPAP. CPAP success (n=151) and CPAP failure (n=84) groups were designated according to outcome within the first 72 h of age. We assessed the ability of radiologic evidence of severe RDS in the initial chest radiograph, alone and in combination with other variables available in the first hours of life, to predict CPAP failure. Severe RDS had a positive predictive value (PPV) of 0.81 (95% confidence interval (CI) 0.64, 0.92) for CPAP failure. The combination of severe RDS and gestational age (GA) ⩽ 26 weeks had a PPV of 0.92 (95% CI 0.68, 0.96). Early radiologic evidence of severe RDS is predictive of CPAP failure, especially in infants with GA ⩽ 26 weeks.

Human infection with a novel avian-origin influenza A (H7N9) virus: serial chest radiographic and CT findings.

Rapidly progressive pneumonia infection with H7N9 virus is a novel disease, and limited information is available concerning serial chest radiographic and computed tomography (CT) findings. The aim of this study was to evaluate the changes in serial radiologic findings in patients with H7N9 pneumonia. The two institutional ethics review boards approved this retrospective study. This study included 10 patients with H7N9 pneumonia. All patients underwent chest radiologic examinations at different time points. Serial radiologic images were systematically analyzed. All patients showed abnormal results on initial chest radiography and CT. The initial radiographic abnormalities were unilateral (n = 9) and bilateral (n = 1), including ground-glass opacities (GGOs) (n = 5) and consolidation (n = 5). The initial CT findings consisted of unilateral (n = 6) and bilateral (n = 4), including consolidation (n = 10), GGOs (n = 10), reticular opacities (n = 2), and pleural effusion (n = 3). Follow-up radiologic findings showed rapid development of consolidation or GGOs within two weeks after illness onset. Pneumomediastinum with secondary subcutaneous emphysema and pneumothorax were noted in two patients. Follow-up high resolution computed tomography (HRCT) after two weeks showed slow improvement in both size and opacity of the lesions. On HRCT after discharge, patients had substantial residual lesions such as irregular linear opacities, reticular opacities, parenchymal bands, traction bronchiectasis, and cystic lesions. The most common radiologic findings at presentation are multifocal or diffuse areas of consolidation and GGOs in H7N9 pneumonia. HRCT in sequence can show more changes in rapid progression of disease and a slow decrease of both size and opacity of the lesions plays an important role in the evaluation of H7N9 pneumonia.

0043 Benign pleural abnormalities and mesothelioma among asbestosis workers in Hong Kong

ObjectivesTo evaluate whether the presence of pleural abnormalities was a reasonable marker to predict mesothelioma among workers with asbestosis in Hong Kong.MethodThis is a historical cohort study comprised of 99...

Minimally displaced clavicle fracture after high-energy injury: are they likely to displace?

Nondisplaced or minimally displaced clavicle fractures are often considered to be benign injuries. These fractures in the trauma patient population, however, may deserve closer follow-up than their low-energy counterparts. We sought to determine the initial assessment performed on these patients and the rate of subsequent fracture displacement in patients sustaining high-energy trauma when a supine chest radiograph on initial trauma survey revealed a well-aligned clavicle fracture. We retrospectively reviewed the cases of trauma alert patients who sustained a midshaft clavicle fracture (AO/OTA type 15-B) with less than 100% displacement treated at a single level 1 trauma centre between 2005 and 2010. We compared fracture displacement on initial supine chest radiographs and follow-up radiographs. Orthopedic consultation and the type of imaging studies obtained were also recorded. Ninety-five patients with clavicle fractures met the inclusion criteria. On follow-up, 57 (60.0%) had displacement of 100% or more of the shaft width. Most patients (63.2%) in our study had an orthopedic consultation during their hospital admission, and 27.4% had clavicle radiographs taken on the day of admission. Clavicle fractures in patients with a high-energy mechanism of injury are prone to fracture displacement, even when initial supine chest radiographs show nondisplacement. We recommend clavicle films as part of the initial evaluation for all patients with clavicle fractures and early follow-up within the first 2 weeks of injury.