Roentgenographic Signs Research Articles

The computer evaluation and diagnosis of congenital heart disease, using roentgenographic findings.

Many roentgenographic signs have been described (2,4,8, 9, 11, 13, 18) which are considered characteristic of specific congenital heart abnormalities, but no single study has examined the frequencies with which each of these signs is distributed over a broad spectrum of congenital defects. This study evaluates the occurrence of 20 roentgenographic parameters as found in 9 uncomplicated congenital heart lesions. The 9 lesions include secundum type of interatrial septal defect (IASD), primum type of interatrial septal defect, interventricular septal defect (IVSD), patent ductus arteriosus (PDA), tertralogy of Fallot, coarctation of the aorta, pulmonary valve stenosis, aortic valve stenosis, and complete transposition of the great vessels. These defects comprise about 87 per cent of all congenital heart deformities (10). An accurate evaluation of the 20 roentgenographic parameters and their occurrence in different congenital heart lesions required a rapid and uniformly consistent method of handling data. The digital computer was utilized to compile and analyze over 3,000 bits of information collected during this study. The computer analysis has included absolute and relative frequency distributions for the various radiographic signs. From this data a frequency distribution matrix (Fig. 3) has been constructed from which the computer, using Bayes' theorem of inverse probability (14, 22), or a radiologist by visual inspection, can diagnose one of the 9 different cardiac lesions. A discussion of the Bayesian method as applied to computer diagnosis is presented. Computers are finding increased and varied applications in radiology (5, 15–17, 20, 23). But before a computer can be intelligently programed to perform a task or solve a problem, the radiologist must objectively identify and methodically analyze all the roentgenographic information used in his decision-making processes. Then the computer can evaluate this information statistically and determine its validity. The results obtained may cause the radiologist to reassess and reorganize his pattern recognition. Thus, not only is the computer fast and consistent, but the exacting, systematic manner of film analysis imposed is an excellent tool for teaching and research. Once instructed, the computer will go completely through the programed sequence and consider each roentgenographic parameter in relation to every diagnosis for which it has information; it is tireless and never has mental lapses. Material and Methods A total of 231 cases have been reviewed. Figure 2, A shows the number of cases evaluated for each of the 9 different “pure” congenital heart defects. The lack of sufficient case material necessitated omission of the rarer cardiac lesions from the study at this time. Every case has been proved at autopsy, surgery, or by cardiac catheterization and angiography. The different roentgenographic parameters recorded for each patient are illustrated by the worksheet in Figure 1.

The accuracy of the roentgenologic diagnosis of chronic pulmonary emphysema.

The diagnosis of chronic pulmonary emphysema may be made with considerable accuracy in many instances. However, it is well recognized that this disease may exist without any clinical manifestations and that its clinical and physiologic manifestations in symptomatic patients are not unique but also occur in other pathologic conditions. The relative value of the chest film as an aid to the accurate diagnosis of emphysema has not been clearly defined. Most of the previous descriptions of the roentgenographic appearance of the chest and studies of the correlation between roentgenographic findings and diagnosis of emphysema have relied upon clinical or physiologic criteria or both for diagnosis. Utilizing clinical criteria, Kerley and associates (1) described the roentgenographic essentials as increased lung translucency, widened intercostal spaces, flattened depressed diaphragms, and widened costaphrenic angles. Parkinson and Hoyle (2) emphasized the frequent enlargement of the pulmonary conus and hilar pulmonary arteries as additional useful roentgenographic features. To the above signs, Lodge (3) added the findings of increased clarity and decreased diameter of second and third order intrapulmonary blood vessels. Whitfield and his associates ( 4) studied these characteristics in fifty-two patients judged to have moderate or severe emphysema on the basis of clinical and lung volume studies. They concluded that although chest films may provide evidence of emphysema, many of the previously described roentgenographic characteristics could be misleading. Knott and Christie (5) subjected the customarily accepted roentgenographic signs of emphysema to the test of blind roentgenographic interpretation by four

The Value of the Double-Track Sign as a Differentiating Factor between Pylorospasm and Hypertrophic Pyloric Stenosis in Infants

The development of vomiting in the infant after the immediate neonatal period frequently requires radiographic investigation of the underlying cause. The classical case of hypertrophic pyloric stenosis presents little problem, but an infant with a severe and prolonged pylorospasm may be difficult to differentiate from one with hypertrophic pyloric stenosis. In this communication, a group of proved cases of hypertrophic pyloric stenosis is compared with a similar group of cases of pylorospasm to determine identifying features of each. The main roentgenographic signs of hypertrophic pyloric stenosis are the string (Fig. 1), the shoulder (Figs. 1 and 2), the beak (Figs. 1 and 3), and the tit (Figs. 1 and 4). With the string sign an area of constant narrowing appears to be rigid and free of peristaltic activity in the prepyloric region and pylorus. This is due to the restriction of distensibility by the hyper-trophied muscle of the pylorus. The narrowed channel presents a curve upward and slightly to the left...

The earliest roentgenographic signs of carcinoma of the lung

The earliest roentgenographic signs of carcinoma of the lung

The Earliest Roentgenographic Signs of Carcinoma of the Lung

ABSTRACT Despite the more general use of sputum cytology and bronchoscopy, the most available, least expensive, and simplest method for the detection of a malignant lesion in the lung, when it is small, is roentgen examination.4 A single posteroanterior roentgenogram made in inspiration is an effective method for finding cases in their presymptomatic stage. An additional number of small lesions would be discovered if it were possible to add a second film so that stereoscopic or posteroanterior and lateral views would be made in each case. Obviously, additional roentgenograms, such as those made in the oblique positions, apical lordosis, and in expiration would increase the productivity, but it is impractical to make such elaborate examinations in asymptomatic individuals. The presence of symptoms which are at all suggestive of carcinoma of the lung should lead to such a thorough investigation, to which should be added body-section roentgenography and, if needed, bronchography.

The computer analysis and diagnosis of gastric ulcers.

THE VALUE of roentgenographic examination of the stomach in patients with upper gastrointestinal symptoms is well established (10, 12), and the accuracy of the roentgenologist in detecting all stomach abnormalities has been variously cited to be between 85 and 95 per cent (1, 3, 4, 7, 10). Even so, one of the most controversial differential diagnoses confronting a radiologist is that of whether a gastric ulcer is benign or malignant (15). Many roentgen signs have been described which are thought to be of value in making this differentiation, but the statistical significance of the various clinical findings and roentgenographic signs has never been established. The use of computers in analyzing data relating to medical disease entities is widely accepted. Computer diagnosis has exceeded the diagnostic accuracy of the trained radiologist in selected bone tumors (8). Radiographic manifestations of carcinoma of the lung have also been evaluated by computer technics (9). The statistical evaluation of 70 radiographic signs and clinical findings pertaining to benign and malignant gastric ulcers is presented in this communication. Computer versions of standard statistical tests have been utilized. From the statistically significant information so obtained, a computer program for diagnosing malignant versus benign gastric ulcers has been developed and tested. Materials and Methods In the review of 65,000 hospital admissions, 496 histologically proved benign or malignant gastric lesions were encountered. Of these, 178 were incidental findings at autopsy or at surgery without previous x-ray examination. Of the remaining 318 patients, 93 had roentgenograms suitable for retrospective analysis. There were 68 benign and 25 malignant ulcers. Forty-two cases of nonulcerating gastric neoplasms were also found. Following a review of the literature, a list of 70 clinical and laboratory findings and roentgenographic signs was compiled (Figs. 4 to 6). The characteristic features of each x-ray finding were identified, subdivided, and assigned a number (Figs. 2 and 3). To promote objectivity on the part of the examiners, line drawings defining certain roentgen features and terminology were prepared (Fig. 1). The roentgenograms were analyzed in a double-blind fashion with the examiners knowing only that a histologically proved ulcer was demonstrated on each. The histologic results were not available to the examiners. After the analysis had been recorded on a work sheet, the information was transferred to punched data cards to facilitate computer analysis. A computer program was employed to provide the absolute, relative, and cumulative frequency distribution of the 70 variables. The Chi-square test was used to identify those variables associated with ulcer type having a probability of 0.05 or less that the association was due to chance. Seventeen statistically valid objective variables were found.

ACUTE TRAUMATIC RUPTURE OF THE THORACIC AORTA DEMONSTRATED BY RETROGRADE AORTOGRAPHY.

The diagnosis of acute traumatic rupture of the thoracic aorta is being made with increasing frequency (2, 9, 12), most cases being produced by automobile accidents. The severity of the injuries sustained is such that only about 10 to 20 per cent of the victims survive the initial trauma (3, 10, 15). The correct diagnosis is almost entirely dependent upon roentgenographic examination of the chest. Widening of the mediastinum with or without rib fracture is the cardinal sign. Hemothorax, usually left, may be present. Aortography is the usual definitive diagnostic procedure, not only in confirming the lesion, but also in localizing the position and degree of the tear. Most authorities advise surgical intervention as soon as such a diagnosis is established (6, 7, 9). A review of the literature reveals a total of 12 successfully repaired acute aortic ruptures (1, 4, 7, 8, 11, 12), 8 of which were demonstrated preoperatively by intravenous or antegrade aortography. In one unsuccessful case, the lesion was visualized preoperatively by a percutaneous left ventricular injection (15). The literature contains no instance of an acute aortic rupture confirmed by retrograde aortography. Case Report C. M. B., a 37-year-old white male, was found slumped in the front seat of a wrecked car. Upon arrival at the emergency room, he was combative, cyanotic, and smelled of alcohol. Physical examination and appropriate roentgen studies revealed a right pneumothorax, a widened mediastinum, and fractures of the mandible, left clavicle, and left forearm (Fig. 1). No rib fractures were present, but the diagnosis of aortic rupture was strongly suspected from the clinical and roentgenographic signs. Following restoration of the blood pressure with transfusion, retrograde aortography was performed via the right femoral artery, utilizing an Ödman catheter. The guide wire curled in the superior portion of the descending aorta several times prior to passage, but the catheter then passed without difficulty. Forty-five milliliters of 80 per cent sodium iothalamate (Angio-Conray) was injected at a pressure of 8 kg per square centimeter. Figure 2 shows the rupture of the descending aorta just distal to the level of the ligamentum arteriosum. An irregularity was also noted at the origin of the left subclavian artery, which was suggestive of an avulsion. Thoracotomy performed under left atrial-femoral bypass disclosed a large mediastinal hematoma. Three-quarters of an inch distal to the left subclavian artery, a circumferential tear involved the entire thickness of the aortic wall and 90 per cent of the circumference. Additionally, a 3/8 in. longitudinal tear adjacent to the take-off of the left carotid artery and a 1/2 in. tear in the ascending portion of the aorta were found. The patient did not survive surgery. Autopsy confirmed the aforementioned aortic tears and disclosed multiple intimal tears extending throughout the descending thoracic aorta and into the abdomen.

Bacterial Arthritis of the Hip in the Adult

A retrospective study of bacterial arthritis of the hip in twenty-six adults seen in the years 1942 through 1962 was made. Only patients in the original phase of the hip infection were included bacterial arthritis associated with a specific disease such as brucellosis or tuberculosis was not included. Follow-up information was available on all but one patient and bacteriological information was available on all. There appeared to have been a real increase in the incidence of bacterial arthritis of the hip in adults in recent years. Diagnosis in these adults was often delayed even though symptoms and signs pointed to involvement of the hip by an infectious process. Staphylococcus aureus caused slightly more than 60 per cent of the infections. Roentgenographic signs of capsular distention occurred later than they do in children. One should compare both hips and look for osteoporosis and slight joint narrowing in the earlier stages. Disability tended to be severe. Only nine of the twenty-six patients were rehabilitated so that they could return to work or to the level of activity they had prior to their illness. Hip function returned to the preinfection range of motion in only 12 per cent of patients. Surgical treatment in the adult should be aimed at early and adequate drainage of the hip joint followed by further débridement if surgical drainage does not control the infection. The hips that proceeded to bony ankylosis gave the best result in this series, except for a few special instances. Prolonged immobilization in a cast, in the hope that spontaneous ankylosis will occur, is usually fruitless. We were unable to assess the specific effects on healing produced by antimicrobials, but we believe that they may prevent death as well as distant metastatic infections.

Pulmonary Thromboembolism : Atypical Clinical and Roentgen Manifestations

Thromboembolism is the most common acute pulmonary disease in the adult population of a general hospital, but its protean manifestations make its diagnosis difficult, both clinically and radiographically. The vast majority of emboli arise from leg veins, but in situ thrombosis of the pulmonary arteries occurs rarely in patients with chronic lung disease or altered pulmonary circulation. Thromboembolism without infarction seldom causes obvious clinical or x-ray findings. Most patients have no symptom, but dyspnea or tachypnea are the most frequent complaints. Physical findings are elusive, but some patients have cor pulmonale. Electrocardiogram changes are common, but often non-specific. Roentgenographic signs, which are uncommonly seen, include: (a) increased radiolucency of the involved lung; (b) enlarged proximal pulmonary arteries; (c) truncation of arteries; (d) calcified thrombi; (e) pulmonary hypertension and cor pulmonale. Pulmonary infarction develops in only a fraction of the patients having thromboembolic episodes. In general, infarcts occur only when there has been some compromise of the bronchial circulation which most often is the result of cardiovascular disease, particularly congestive failure. Only about a third of the patients with infarcts have the classic symptoms of acute pleuritic pain and hemoptysis. Fever and leukocytosis are among the most frequent signs, leading to a mistaken diagnosis of pneumonitis. The typical x-ray change of infarction is a homogenous rounded density adjacent to a pleural surface in a lower lung field. Cardiomegaly, pulmonary congestion and pleural effusion are often associated. Atypical x-ray changes which are sometimes seen include: "negative" film, "coin" lesion, lobar consolidation, massive effusion, cavitation and pseudotumor.

PROBLEMS IN DIAGNOSING OSTEOARTICULAR TUBERCULOSIS.

Five patients with osteoarticular tuberculosis were presented as diagnostic problems because each was initially thought to have some other disease. Several factors were cited as reasons for the delay, including unusual sites of involvement, the lack of detectable pulmonary involvement, secondary pyogenic infections, and the absence of classical roentgenographic signs. A more general factor is attributable to a decrease in the incidence of tuberculosis in this country and alterations in the method of handling patients with this disease. In addition, there has been some evidence, supported by these cases, that the pattern of osteoarticular tuberculosis may be changing.

INTRAMURAL HEMATOMA OF DUODENUM AND JEJUNUM.

ROENTGENOGRAPHIC DIAGNOSIS of intramural hematoma of the duodenum or jejunum, due either to trauma or to hemorrhagic states, is being made with increasing frequency. Many of the cases reported have not been proved except by followup course and subsequent studies showing a disappearance of the roentgenographic signs pari passu with the improved situation and disappearance of symptoms.1-3 The most skeptical can hardly doubt the validity and significance of the roentgenographic signs when the condition is confirmed by surgery. The following case is being reported inasmuch as it presents the characteristic roentgenographic signs, was diagnosed prior to, and proved by, surgery, as well as by a postoperative followup examination. Report of a Case A 20-year-old white male was admitted to the hospital, with the chief complaint of nausea and vomiting for five days. One day before the onset of symptoms, his hand had been injured in an automobile accident. He

ROENTGENOGRAPHIC AND PATHOLOGIC ASPECTS OF INTESTINAL SCLERODERMA.

Article1 December 1963Roentgenographic and Pathologic Aspects of Intestinal SclerodermaE. RALPH HEINZ, M.D., ALLEN J. STEINBERG, M.D., MARVIN A. SACKNER, M.D.E. RALPH HEINZ, M.D.Search for more papers by this author, ALLEN J. STEINBERG, M.D.Search for more papers by this author, MARVIN A. SACKNER, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-59-6-822 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe atonic esophagus which empties only with the aid of gravity is a well known roentgenographic sign of scleroderma. It has been a useful corroborative finding in this disease. Most authors have emphasized the nonspecific nature of the abnormalities in the remainder of the gastrointestinal tract while conceding that the proximal small bowel is more severely involved (1-4). In recent years, it has been established that the patients may present with characteristic visceral manifestations of scleroderma with little or no skin alterations (5). The purpose of the present study is to direct attention toward recognition of specific roentgenographic signs of...

Amelogenesis imperfecta: A report of two cases

1. 1. The dental symptoms presented by the two cases reported here are compatible with the classic descriptions of enamel hypoplasia, enamel hypocalcification, and associated osteogenesis imperfecta. 2. 2. Because of the hereditary nature of the condition, the clinical and roentgenographic signs may serve as a guide in treatment planning for the patient and members of the family as related to the quality of the calcific structures (specifically, enamel and bone).

Evaluation of Some Roentgenographic Signs in Sickle Cell Anemia and Its Variants

Evaluation of Some Roentgenographic Signs in Sickle Cell Anemia and Its Variants

An evaluation of some roentgenographic signs in sickle cell anemia and its variants.

An evaluation of some roentgenographic signs in sickle cell anemia and its variants.

Roentgenographic signs produced by Taenia saginata.

1. Radiolucencies can be produced in the small bowel showing the presence ofTaenia saginata.

Traumatic rupture of the spleen

1. 1. Problems in diagnosis and management of seventy-one cases of traumatic rupture of the spleen seen in Hurley Hospital in a tenyear period are presented. 2. 2. Rupture of the spleen is the most common of all major abdominal injuries in man. The fixed anatomic location and the soft, friable nature of the spleen are responsible for its susceptibility to rupture and subsequent hemorrhage. 3. 3. This injury is more frequent in males by a ratio of about two to one. The male between eleven and fifty years of age is most commonly afflicted. 4. 4. Automobile accidents account for 78 per cent of the cases reported. Penetrating wounds of the abdomen and falls are the next most frequent causes of splenic rupture. 5. 5. Abdominal pain is the outstanding complaint. Pain in the left shoulder (Kehr's sign) occurred in only 25 per cent of the patients. The symptoms occurred within the first twenty-four hours after trauma in 70 per cent of the cases. 6. 6. The most prominent abdominal finding was generalized or localized tenderness in the left upper quadrant. Fixed dullness in the left flank and shifting dullness in the right (socalled Ballance's sign) was an extremely rare finding. 7. 7. Injury to the spleen alone is unusual. 8. 8. The most common associated injury was fractured ribs, eight, nine, and ten on the left. Fractured extremities were the next most common associated injury. The most serious and commonly found complication of the associated injuries was left “traumatic wet lung.” 9. 9. Severe anemia upon admission was found in less than 50 per cent of the patients; however, a reduction in hemoglobin after admission was significant in the evaluation of intraabdominal hemorrhage. The white blood cell count was elevated above 10,000 per cu. mm. in over 65 per cent of the patients. A shift to the left in the differential count was present in all. Urinalysis was helpful only in eliminating genitourinary injury. 10. 10. Prominent roentgenographic signs were gastric dilatation with adynamic ileus and density in the left upper quadrant. A suspected or definite diagnosis of splenic rupture can be made from roentgenograms in 50 per cent of the cases. 11. 11. The immediate postoperative complication most commonly found was adynamic ileus. A late postoperative complication of splenosis is reported. 12. 12. Lacerations to the capsule and the parenchyma of the splenic tissue were found in over 70 per cent. Sharp laceration and stab wounds of the spleen produced minimal hemorrhage. 13. 13. Lacerations produced by blunt trauma result in more severe hemorrhage and shock than injury caused by a sharp object. 14. 14. The treatment for splenic rupture is splenectomy with blood replacement. All but one of the patients required blood transfusions. The average amount given to each one was 1,706 cc. 15. 15. The operative mortality was 12 per cent and the over-all mortality was 25 per cent.

Relationship of three-hour blood glucose to oral roentgenographic findings.

1. 1. This report analyzes the relationship of two roentgenographic signs (alveolar bone loss and periodontal widening) to the three-hour blood true glucose level in a group of 100 routine dental patients. 2. 2. An examination of the available data points out the need for evaluating edentulous patients as to the cause of loss of teeth. 3. 3. An analysis of the mean score values for the two signs, independently and combined, shows that the lowest values were found in the 70 to 79 mg. per cent blood glucose groups. 4. 4. A study of the individual scores (as expressed by the coefficients of variation) demonstrates that, in general, the individual values cluster more closely about the mean in the > 100 mg. per cent blood glucose group than in any of the other categories. 5. 5. An analysis of the significant probability values shows that a significant difference exists between the 70 to 79 and > 100 mg. per cent three-hour blood glucose groups for both of the roentgenographic signs, singly and in combination. 6. 6. The findings in this report suggest that the two roentgenographic signs (alveolar bone loss and periodontal widening) are associated with both hyper-and hypoglycemia. 7. 7. The evidence derived in this report suggests that factors intimately associated with increasing age parallel increasing hyper- and hypoglycemia and the relationship of glucose imbalance with these two roentgenographic signs. 8. 8. These data suggest that the range of three-hour blood glucose normality may be more narrow than usually accepted. 9. 9. The findings of this study and other data obtained from analyses of the fasting 2 and two-hour 3 blood glucose levels point to ranges of blood glucose uormality for determinations made at these times. Specifically, the fasting range is 70 to 79 mg. per cent, the two-hour range is 80 to 89 mg. per cent, and the three-hour range is again 70 to 79 mg. per cent of blood glucose.

Roentgenographic findings in an early case of linitis plastica.

The typical roentgenographic aspect of linitis plastica has been that of leather bottle stomach. This study describes roentgenographic signs that appear before this deformity. The clinical history of a 44-year-old woman included complaints of heartburn and mild gastric pains but no other signs of serious disease. Roentgenographic examination showed a hook-formed stomach, with abnormalities limited to an irregular area on the greater curvature. Here the mucosa had an irregular surface, whereas normal folds were found everywhere else. Peristalses passed over the lesion, and the rest of the greater curvature was pliable. At operation, an early stage of linitis plastica was found.

ACUTE SUPPURATIVE ARTHRITIS IN INFANTS AND CHILDREN

Tardily treated suppurative arthritis in infants and children results in permanent disability. Early diagnosis determines ultimate prognosis. In doubtful cases, the diagnosis should be established by aspiration or exploratory arthrotomy if necessary. This is particularly important in the newborn infant. Diagnostic aspiration should precede the administration of any antibiotic. Incision and drainage is the preferable method of evacuating an acutely infected joint. Symptoms of residual incongruity of a joint lag far behind the roentgenographic signs and do not ordinarily appear until the third decade of life.