Routine Chest Films Research Articles

Pulmonary Adenofibromas: A Clinicopathologic Correlation of 13 Cases.

Thirteen cases of primary pulmonary adenofibromas are presented. The patients are 8 women and 5 men between the ages of 41 and 73 years (average: 57 y). The patients presented with nonspecific symptomatology or their tumor was identified during routine chest films. A wedge resection was performed in all cases with lymph node sampling. Grossly, the tumors varied in size from 1 to 2.5 cm in greatest dimension. The entire tumor was histologically evaluated in all cases. All the tumors shared similar histologic features namely leaf-like/phyllodes-like growth patterns with varying areas of sclerosis, focal inflammation, and entrapped epithelium. A wide panel of immunohistochemical studies was performed including epithelial, neural, muscle, and vascular markers, all of which showed negative staining. The tumors were positive only for vimentin in the stroma and keratin in the entrapped epithelium. Further evaluation in 6 cases using in situ hybridization for the solitary fibrous tumor was performed and was negative. Clinical follow-up in all the patients showed no evidence of recurrence or metastatic disease, during a period of 12 to 36 months. The current cases highlight the unusual occurrence of pulmonary adenofibromas and the importance of separating these tumors from other tumors that may have the potential to recur or metastasize. The use of proper immunohistochemical stains/molecular analysis aids in the proper classification of these tumors.

The utility of routine admission chest X-ray films on patient care

Background Routine chest X-rays are the most widely obtained radiological studies during hospital admissions. In this study, we evaluated the utility of routine admission chest X-rays on patient care in patients admitted to The Brooklyn Hospital center. Methods We included consecutive patients admitted to the medical floors during a 4-month period who had a chest X-ray done on admission. The medical records of patients who had chest X-ray on admission were reviewed to identify any impact of chest X-ray on patient care during the course of hospitalization. Results Chest X-ray was noted to be done in 229 patients on admission. Chest X-rays of 100 (43.6%) patients were deemed medically necessary because of the presenting complaints which included cough (15.2%), fever (13.1%), dyspnea (6.1%), hemoptysis (1.7%), and combined symptoms (7.4%). Routine chest X-rays were done in 129 (56.3%) patients to rule out occult findings in the absence of any symptoms. Chest X-ray abnormalities were noted in 56 of 129 (43.4%) patients. In 51 of 56 patients, abnormalities were chronic, stable and previously known and did not contribute to patient care. In only 5 of 129 (3.87%) patients, there were findings which necessitated a change in patient care. Conclusion We conclude that routine chest films rarely reveal clinically unsuspected findings. The overall impact on patient care based on these findings is small when compared to the risks associated with repeated exposure to radiation. We recommend that routine chest X-ray films should not be ordered solely because of hospital admission.

Extrapleural hematoma as an unexpected finding on a follow-up chest X-ray after coronary surgery

We present two cases of an extrapleural hematoma, on a follow-up chest X-ray after coronary artery bypass surgery using an internal mammary artery (IMA). In both cases, the finding was disclosed on a routine chest film obtained 1 month post-operatively, in a patient who was either asymptomatic or had nonspecific symptoms. Follow-up chest films showed spontaneous resolution in both patients. We emphasize the recognition and significance of such a self-limited post-operative radiological finding.

The utility of oblique rib radiographs

A retrospective study of 620 consecutive rib series examinations was conducted to determine their usefulness. A total of 546 examinations were performed for rib trauma or rib pain or tenderness. There was no difference in treatment between patients with radiographically confirmed fractures and those with focal rib pain/tenderness secondary to trauma but without confirmed rib fracture. The additional expense of obtaining radiographic confirmation of rib fractures is not justified. Only complications of rib fractures influence management and these are best seen on routine chest films. Rib radiographs are useful if patients have a malignancy and associated rib pain or an abnormal bone scan.

The cardiac silhouette.

The cardiac silhouette as seen on a routine chest film contains considerable information regarding the presence of heart disease, the nature and severity of the disease, and its prognosis. The changes that are seen directly reflect the altered anatomy and physiology of the heart. Appreciation of these factors allows for a reasonable, logical approach to interpretation of the cardiac silhouette.

PLAIN FILM DIAGNOSIS OF COMMON CARDIAC ANOMALIES IN THE ADULT

Congenital cardiac lesions in the adult have characteristic roentgen patterns that should be recognized by the radiologist. In other instances, abnormalities in the aorta or the position of the organs can indicate the likelihood of associated cardiac anomalies. An increasing number of congenital cardiac patients are surviving into adult life because of successful treatment. Some of the complications of these repairs can be recognized on routine chest films.

A Clinical Review of Primary Tracheal Carcinoma

BACKGROUND: Primary malignant tumors of the trachea are extremely rare entities and account for a mere 0.1 percent of all malignancies of the respiratory tract Because of vague localizing signs, symptoms and a usually negative routine chest film, the patients with tracheal tumors are often treated for asthma or chronic obstructive pulmonary disease for considerable period of time before correct diagnosis. METHODS: We Have made a review of the 17 cases of primary tracheal tumors in recent 15 years. We reviewed the clinical features including history of smoking arid respiratory symptoms, the official readings of initial routine chest film, the cytologic examination of sputum, the time of delay in diagnosis, and the response according to the therapeutic modalities. RESULTS: Eight out of 9 patients with squamous cell carcinoma(SCC) were above 50 years old, five out of 6 patients with adenoid cystic carcinoma(ACC) were below 50 years old. The most common location of primary tracheal tumors was the upper one-third of trachea in 8 cases(47%). The most frequent symptoms were dyspnea in 13/17 cases(76%) and then strider or wheezing, cough, and sputum in order. The routine chest roentgenographic examinations wore not helpful to diagnose tracheal carcinoma and the cytologic examinations of sputums were helpful to diagnose tracheal carcinoma in only one case with adenocarcinoma. The mean times of delay in diagnosis of patients with SCC and ACC were S months and 24.9 months respectively. We bad bronchial asthma in 8 cases(47%) and tracheal tumors in 4 cases(23%) as initial clinical impression CONCLUSION: We would like to perform more comprehensive diagnostic too]s(high KVP technique, the fibroptic bronchoscopic examination, chest CT scan etc.) in patients who had the suggestive points for the tracheal tumors(1. unexplained hemoptysis or hoarsness, 2. inspiratory wheezing or stridor, 3. wax arid waning of dyspnea according to changes of position. 4. progressive asthmatics unresponsive to antiasthmatic therapy) and radical resection of tumor or external radiation therapy with curative aim as possible.

Chronic cough

Chronic cough is a common symptom presenting to all clinicians. Every effort should be made to determine the cause(s) of cough because specific therapy has a higher likelihood of success than empiric therapy. Evaluation begins with a complete history, physical examination, routine health screen laboratory testing, chest film, and pulmonary function testing. Further investigation should be guided by the response to treatment of the most likely diagnostic possibilities: postnasal drip, cough-variant asthma, gastroesophageal reflux, chronic bronchitis, bronchiectasis, and ACE inhibitor induced. The majority of each patient's workup can be performed and ordered by the primary care physician.

Surveillance after treatment for well differentiated thyroid cancer: Audit for chest radiography

Well differentiated thyroid carcinoma has an excellent prognosis, with many patients achieving cure. The incidence of pulmonary metastases is about 11%. When thyroid ablation has been used in the initial treatment, serial thyroglobulin (Tg) levels are a sensitive marker of recurrent disease. Data regarding the usefulness of chest radiography (CXR) in monitoring relapse in these patients does not exist and regular CXRs continue to be performed as routine surveillance. To assess their efficacy we have reviewed all serial CXRs and corresponding Tg levels on every patient with well differentiated thyroid cancer who was treated and followed up at the Royal Marsden Hospital between 1984 and 1987. A total of 369 CXRs were performed on 49 patients, with a median follow-up of 81 months. Of these, only 15% were undertaken for a clinical reason with 85% being requested as routine. Seven patients developed lung deposits, six of whom had CXR performed because of elevated Tg, abnormal 131I uptake imaging or thoracic symptoms. In no case were lung metastases diagnosed by routine CXR in an asymptomatic patient. The cost of routine chest films for the duration of this study was approximately £13 500. It is concluded that routine chest radiography is neither cost effective nor a sensitive method of screening for relapse in asymptomatic well differentiated thyroid cancer. It should be reserved for patients with chest symptoms, or those in whom Tg has been shown not to be a useful marker of disease.

Value of routine preoperative chest x-rays: a meta-analysis.

The purpose of this study was to estimate the frequency with which routine postoperative chest x-rays lead to clinically relevant new information. All articles in English, French and Spanish relating to routine chest radiography in North American or European populations were reviewed, using the Medline database and references listed in reviews and periodicals published from 1966 to 1992, inclusive. Twenty-one reports which supplied sufficient information were included for meta-analysis. On average, abnormalities were found in 10% of routine preoperative chest films. In only 1.3% of films were the abnormalities unexpected, i.e., were not already known or would not otherwise have been detected (95% CI: 0 to 2.8%). These findings were of sufficient importance to cause modification of management in only 0.1% (95% CI: 0 to 0.6%). The frequency with which the new information influenced health could not be estimated. Assuming only the direct cost to the health care system of each radiograph ($23), each finding which influenced management in any way would cost $23,000. It is concluded that in North American or European populations when a reliable history and a clinical examination are carried out, the cost of this test is so high relation to the clinical information provided that it is no longer justifiable.

World War II Military Led the Way in Screening Chest Radiography

World War I recruits were screened for tuberculosis almost exclusively with a history and physical exam. Radiography was unavailable on a large scale and expensive. New techniques developed in Brazil and elsewhere in the 1930s made mass radiographic screening practical. During World War II, the U.S. Army and Navy took advantage of this new technology to screen an estimated 10 million personnel. This ambitious and successful case-finding program inspired, in part, continuing radiographic screening efforts among the civilian population following the war, including mass screening of asymptomatic individuals and routine hospital admission chest films.

The value of routine expiratory chest films in the diagnosis of pneumothorax.

The value of routine expiratory chest films in the diagnosis of pneumothorax.

地域老年者の大動脈石灰化に及ぼす肥満, 血圧, 総コレステロール, 血糖の影響に関する疫学的検討

Effect of obesity, blood pressure, total cholesterol and fasting blood glucose on aortic arch calcification (abbreviated as calcification) was studied in 495 males and 751 females, aged 65 years or older, living at home in a localized community.Calcification was diagnosed by routine chest film. The proportion of calcification increased with age in both sexes and the proportion was significantly higher in females (27.9%) than in males (21.2%).After adjusting for sex and age, the proportion of hypertension and that of hypergycemia in cases with calcification were significantly higher than in those without calcification.Even when interrelations among multiple factors were adjusted by logistic regression analysis, hyperglycemia was still most significantly related to calcification.

Neck masses: benign or malignant?

Differential diagnosis of cervical masses varies with the age of the patient. In children, neck masses are most likely to be inflammatory or congenital, and evaluation may include routine laboratory evaluation, skin tests, chest films, computed tomography and/or magnetic resonance imaging of the neck, and, possibly, fine-needle aspiration of the mass. The workup in young adults is similar to that in children. In older patients (greater than 40 years), however, the likelihood of malignant disease increases significantly. These patients should have formal endoscopy with biopsy of any suspicious lesions before an open biopsy of the neck mass is performed.

Plain radiographic evaluation of the aorta

As the main trunk of the systemic arteries, the aorta often reflects on chest radiography the status of the left ventricle centrally and the systemic circulation distally. Lesions of the aorta also affect the surrounding structures, providing telltale signs of the overall situation. Although newer imaging modalities have contributed a good deal to the evaluation of the aorta, chest radiography is still the most used baseline study. By first deriving full information from the routine chest films, one can better assess the necessity for and sequence of additional procedures. The use of digital chest radiography, which provides a clearer image of the aorta and surrounding structures, emphasizes the importance of plain-film interpretation. In this article the radiographic signs of aortic diseases in adults are presented.

The anterior wall stripe of the left lower lobe bronchus on the lateral chest radiograph: CT correlative study.

We designed a study to determine whether thickening or effacement of the anterior wall stripe of the left lower lobe bronchus on the lateral chest radiograph implies adjacent disease, as it does for the posterior wall stripe of the right bronchus intermedius. The anterior wall stripe of the left lower lobe bronchus originates from the inferior anterior aspect of the end-on left bronchus and descends in a gentle posteriorly convex curve. The left lower lobe bronchus was identified on routine lateral chest films in 86 of 90 consecutive patients who also had chest CT. In those cases the anterior wall stripe was measured and categorized on chest films. On the CT scans, the length of the left lower lobe bronchus and its relationship to the left lower lobe artery and left upper lobe, lingular, and lower lobe veins were assessed. The presence of adjacent disease was noted. A complete anterior wall stripe was seen in 59 of 86 cases. It was effaced by anterior soft tissue in 15 of 86 cases; in 12 of 86 cases only the superior 0.5-1.5 cm was effaced. A normal anterior wall stripe was as thick as 12 mm in one case, but was 6 mm or less in 90%. Shapes other than linear were common. Anatomic variation accounted for nearly all of these findings. There was no focal abnormality in the 12 cases with partial effacement or in nine of the 15 cases with complete effacement; disease was significant in only two of these six. We concluded that thickening or effacement of the anterior wall stripe is an unreliable sign of disease.

Bronchogenic cysts.

Between 1967 and 1987, 26 patients with bronchogenic cysts were treated in our institution: 15 females and 11 males, ranging in age from 2 months to 14 years (average 6 years, 4 months). Only four patients (15%) were 1 year old or less. Seven patients presented with asymptomatic lesions discovered on chest film. Nineteen patients presented with respiratory symptoms. Of note are the four patients aged 1 year or less, who presented with dyspnea and cyanotic spells. Only one of them presented with dysphagia. All patients underwent routine chest films and tomography and, later, computed tomography (CT) scan of the thorax once the study became available. Barium esophagogram and bronchoscopy were performed as required. Contrary to what has been published concerning the intraparenchymal location of bronchogenic cysts, the majority of the cysts (65%) were located in the mediastinum, usually in close proximity to the carina, mainstem bronchi, trachea, esophagus, or pericardium. Only 27% (7 of 26) were intraparenchymal, and 8% (2 of 26) were situated in the inferior pulmonary ligament. A correct preoperative diagnosis was made in 19 patients (73%). Intrapulmonary lesions were removed by segmentectomy or lobectomy. Cysts located elsewhere were simply excised. Among the cysts adhering to the trachea, 50% (two of four) required suture of the membranous trachea after excision. Postoperative complications included one pneumonia, which responded to antibiotics, and one transient paresis of the right phrenic nerve. Follow-up averaged 17 months (range, 0 to 17 years). No sequelae were noted and all patients were cured.

Do X‐ray determined cardiac volume and signs of congestive heart failure provide additional prognostic information after myocardial infarction if the left ventricular ejection fraction is known?

Cardiac volume (CV) was measured and indices of pulmonary congestion (PCG) were judged from routine chest films taken post myocardial infarction (AMI) in a consecutive series of 477 patients (340 first and 137 recurrent AMIs). Cardiac volume (CV) and signs of PCG were compared to left ventricular ejection fraction (LVEF), measured with isotope technique, and the prognostic value of all the parameters was assessed after 1 and 5 years. The accuracy of CV and PCG in predicting impaired LVEF was low (62% and 50% respectively). Although specificity is suboptimal, however, these parameters provided valuable prognostic information. For example, patients with signs of PCG had a very high 1 and 5 years' mortality, and two-thirds of those who died during the first year of observation had enlarged CV. The independent value of LVEF determination was mainly observed in re-AMI patients. A more restricted use of this expensive procedure may therefore be recommended.

Splenic size on routine chest films in AIDS

Sixty-nine percent of AIDS patients show evidence of splenomegaly on their plain chest film. This splenomegaly is not related to severity of AIDS, to intravenous drug abuse or to any specific infection or neoplasm but correlates well with severity of anemia, pancytopenia, and thrombocytopenia. Increasing splenomegaly usually indicates worsening of AIDS. The triad of splenomegaly, interstitial lung disease sparing the bases, and very thin chest wall soft tissues is highly specific for the diagnosis of AIDS. The sensitivity of the plain film for diagnosing AIDS can be increased by including AIDS in the differential diagnosis of all patients with splenomegaly, intrathoracic lymphadenopathy, cachexia, or bilateral interstitial lung disease of unknown cause.

Influence of Spirometry and Chest Roentgenography on the Management of Pulmonary Outpatients

Spirometry and chest roentgenography are frequently employed to evaluate patients with respiratory problems. To determine their impact on the management of outpatients with lung disease, both tests were performed on 100 consecutive patients (40 men and 60 women; mean age, 52 +/- 15 years) who returned for reevaluation 16 +/- 9 weeks after their previous clinic visit. Patients with obstructive (n = 45), restrictive (n = 35), and mixed (n = 20) lung diseases were initially assessed by history and physical examination and classified clinically as improved, stable, or worse. A clinical management plan (CMP) was formulated based on this initial evaluation. Changes in the proposed CMP due to spirographic or roentgenographic results were then noted. None of the 19 patients who were clinically improved and only two (3%) of the 64 clinically stable patients had a change in CMP. In contrast, five (29%) of the 17 patients whose conditions deteriorated clinically had their proposed CMP modified after review of the spirograms and roentgenograms. Therapy was intensified in three of the seven patients whose CMPs were modified, while in the other four, treatment was withheld because results of both tests were unchanged. These results indicate that routine spirograms and chest films have little influence on the CMP of clinically stable patients. However, unexpected roentgenographic and spirometric findings frequently alter the management of the individual whose condition has clinically deteriorated.