Coralie Shaw

Superior sulcus tumors: the role of imaging.

Advances in the treatment of stage 0 to III superior sulcus tumors mandate greater accuracy in establishing tissue diagnosis, assessing tumor extent, and staging. Currently, this is best accomplished by a combination of PA chest radiography, MRI, and needle biopsy. MRI is superior to other single imaging modalities for the overall assessment of local tumor extent, bone invasion, mediastinal invasion, and perhaps in the future, determining radiosensitivity. In patients with superior sulcus tumors, evaluation of the brain, liver, and skeleton for metastases may be advisable prior to treatment with preoperative radiation and radical surgical resection.

METASTATIC DISEASE TO THE CHEST IN PATIENTS WITH EXTRATHORACIC MALIGNANCY

The search for metastases to the lung parenchyma and other intrathoracic structures is a commonly encountered problem. The radiographic appearance of intrathoracic metastases is varied, and multiple imaging modalities may aid in their detection. Knowledge of relative frequency, growth rates, and mechanisms of spread may guide the sequence of radiographic studies.

Malignancies metastatic to the pleura.

In patients over 50 years of age, neoplasms of the pleura are probably the second most common cause of a pleural effusion after congestive heart failure. Lung cancer, breast cancer, lymphoma, ovarian carcinoma, and stomach cancer are the leading causes of malignant pleural disease, and adenocarcinoma is the most common cell type. This review discusses in detail the etiology and incidence, pathogenesis, clinical manifestations, diagnosis, prognosis, and treatment of neoplasms that involve the pleura with special reference to malignant and paramalignant pleural effusions.

Medical imaging in asthma.

Asthma is a common disease characterized by hyperreactivity of airways to a variety of stimuli Efficacy studies have shown that while in adults there is no positive predictive value between radiographic abnormalities and certain clinical parameters, in children there may be some correlation with age and the presence of rates. In the Yale – New Haven Emergency Service it is suggested that certain clinical criteria be used to determine which patients receive chest radiographs. A retrospective review of 563 adult asthmatics who presented to the Yale Emergency Room revealed that one third of the patients were radiographed; 50% of these were over 50 years of age, and the overall incidence of radiographic abnormalities that would change patient management was only 3%. Radiographic findings have been categorized into two groups, uncomplicated and complicated asthma, depending on whether bronchodilators will effect a response.

Inadvertent bucrylate pulmonary embolization : a case report

Detection of small, dense, rectangular opacities that follow the course of pulmonary vessels on chest radiographs should raise the suspicion of a prior therapeutic occlusion of the blood supply of a mass or of an arteriovenous fistula elsewhere with embolization of the occlusive material to the lungs. This article demonstrates the radiographic findings of such an occurrence in an asymptomatic woman.

Critiquing the process of radiologic differential diagnosis

ICON is a developmental expert system designed to critique the process of radiologic differential diagnosis. To use ICON, a physician outlines (1) findings observed in a chest radiograph, (2) a small amount of clinical information describing the patient, and (3) a proposed diagnosis. ICON critiques the appropriateness of that diagnosis in detail, analyzing why and how well the findings serve to confirm it, or to rule it out. ICON may also suggest further information to look for. ICON explores the design issues involved in critiquing the process of differential diagnosis, and is currently implemented in a limited domain: the radiographic diagnosis of a lung mass in a patient with Hodgkins disease.