Anne McB. Curtis

Air crescent sign of invasive aspergillosis.

Pulmonary infection in immunocompromised patients is frequently difficult to diagnose. Therapy for the more common pathogens differs greatly from that for infection with unusual opportunistic organisms. However, neither of these infectious agents offers specific radiographic signs. The authors report on 4 patients with acute leukemia and invasive aspergillosis whose radiographs demonstrated a distinctive feature of one or more air crescents within an area of pulmonary infiltrate. Autopsy studies correlated the radiographic changes with an infection due to Aspergillus species fungi. While the sign is not pathognomonic for Aspergillus infection, seen in a suitable host, it would suggest the possibility of invasive aspergillosis.

Supradiaphragmatic Hodgkin's disease: significance of large mediastinal masses.

Abstract In order to assess the significance of large mediastinal masses in patients with Hodgkins disease, we analyzed all patients with pathological stage (PS) IA or IIA disease evaluated and treated at Yale between 1969 and 1978. There were 131 such patients treated initially with radical radiotherapy only, combination chemotherapy being reserved for those who failed radiation. Actuarial 5 and 10 year survivals were 95%. The presence of a mediastinal mass reglardless of size did not affect survival. Relapse-free survival was 77% at 5 years, 74% at 10 years in the entire group. Patients with any mediastinal involvement had a 65% relapse-free survival, 72% if the mass was 33%. These differences are suggestive of a greater tendency of such patients to fail radiotherapy but the differences were not statistically significant. Patients who did fail radiotherapy were for the most part successfully retreated with combined modality therapy (chemotherapy and radiation), accounting for the overall survival of 95%. Only 6 patients died of causes related to Hodgins disease and 2 of these deaths were related to combined modality therapy complications. Because of the serious potential long term consequences of combined modality treatment, it should be used with great caution and on an individual basis only in PSIA and IIA patients.

Gray scale ultrasonography, computerized tomography, and nephrotomography in evaluation of polycystic kidney and liver disease

A comparison of gray scale ultrasonography and computerized axial tomography in adults with known adult-type polycystic disease and of ultrasonography and high-dose nephrotomography in their progeny is being conducted. Although all three modalities have proved capable of demonstrating cysts of the kidney and liver, ultrasound has been the most consistent in identifying these lesions. Ultrasound is valuable in diagnosing polycystic disease in adult with large, poorly functioning kidneys; in addition, since cysts could be identified by ultrasound in children who had normal nephrotograms, it provides a safe and useful method of obtaining information for genetic counseling.

Thickening of the posterior tracheal stripe: a sign of squamous cell carcinoma of the esophagus.

A thickened posterior tracheal stripe (wider than 4.5 mm) was identified on the lateral check radiographs of 20 patients with squamous cell carcinoma of the esophagus. Autopsy studies confirmed that peri-esophageal lymphatic involvement was responsible for the thickening of the stripe in the nonobstructed esophagus. This sign appeared on the lateral chest radiograph as early as 6 months prior to the development of symptoms in 50% of the cases studied.

Long-term follow-up of beryllium sensitized workers from a single employer

BackgroundUp to 12% of beryllium-exposed American workers would test positive on beryllium lymphocyte proliferation test (BeLPT) screening, but the implications of sensitization remain uncertain.MethodsSeventy two current and former employees of a beryllium manufacturer, including 22 with pathologic changes of chronic beryllium disease (CBD), and 50 without, with a confirmed positive test were followed-up for 7.4 +/-3.1 years.ResultsBeyond predicted effects of aging, flow rates and lung volumes changed little from baseline, while DLCO dropped 17.4% of predicted on average. Despite this group decline, only 8 subjects (11.1%) demonstrated physiologic or radiologic abnormalities typical of CBD. Other than baseline status, no clinical or laboratory feature distinguished those who clinically manifested CBD at follow-up from those who did not.ConclusionsThe clinical outlook remains favorable for beryllium-sensitized individuals over the first 5-12 years. However, declines in DLCO may presage further and more serious clinical manifestations in the future. These conclusions are tempered by the possibility of selection bias and other study limitations.

Comparison of Two Methods for Ranking Applicants for Residency

Ranking radiology residency applicants is a complex process. Multiple factors, such as the variability in evaluation of candidates and the sometimes excessive subjectivity experienced, may influence the final outcome. To address inconsistencies, Yale Universitys selection committee integrated a mathematical model of ranking. The goal is to compare the mathematically generated rank list with the traditional committee-derived list to identify applicants with discrepancies between the two rank orders as a safety net to ensure that the final rank order list reflects true committee consensus. For three consecutive years, beginning with the 2006-2007 interview season, three rank order lists were compiled. The subjective list was developed by committee consensus on appropriate rank for each applicant. The mathematical list was developed using an equation to assign a score from each of an applicants three interviewers, which were then averaged and arranged in descending order. These two lists were compared to identify applicants who had differences of 10 rank order positions. Identified applicants were reassessed and reassigned if necessary, forming the National Resident Matching Program (final) list submitted for the match. Over three years, 224 applicants were ranked in total, with 109 being reevaluated (49%) and 24 ultimately reassigned (11%). Discrepancies in rank on the two lists were identified and discussed. In some but not all cases, the discrepancies were remedied. Reasons for discrepancies are discussed. The mathematical method used in parallel with the subjective method has proved useful in identifying misplaced applicants and provided assurance that the final rank list reflects the committees evaluation of each applicant.

Roentgen manifestations of carcinoma in the gastric remnant

Awareness of the increased incidence of carcinoma in the gastric remnant has not been accompanied by improved diagnosis or prolonged survival. The long latent period prior to development of tumor, the insidious nature of symptoms, and the anatomical distortion produced by surgery contribute to the difficulty in detection of these lesions. The radiological spectrum of carcinoma of the gastric remnant is discussed and both characteristic and unique radiographic features are illustrated.

Role of intravenous urography in clinical assessment of polycystic kidney disease

This study is a retrospective review of 30 patients with polycystic kidney disease analyzing the quantitative measurements of renomegaly reported in the literature and the correlation of radiographic findings with the clinical complications of uremia, hypertension, infection, and the need for dialysis. The only significant correlation noted was between renal size and the presence of infection. There was no significant correlation between renomegaly and the presence or development of hypertension, uremia, and the need for chronic dialysis.