Irena Tocino

Computed tomography in blunt chest trauma.

While most injuries to the chest can be diagnosed by a portable supine radiograph, computed tomography (CT) adds significant findings that will influence patient management. In addition to requested CT chest examinations, we routinely obtain a limited chest CT during the initial work-up of traumatized patients referred to our radiology department for other CT examinations. The major categories of new information provided by CT are: occult pneumothorax, malposition of chest tubes, inadequately drained pleural collections, differentiating between posttraumatic abscess and empyema, noninvasive diagnosis of tracheal rupture, and cause of mediastinal widening.

Chest radiograph interpretation of Pneumocystis carinii pneumonia, bacterial pneumonia, and pulmonary tuberculosis in HIV-positive patients : Accuracy, distinguishing features, and mimics

The purpose of this study was to assess the accuracy of chest x-ray (CXR) interpretation in the diagnosis of Pneumocystis carinii pneumonia (PCP), bacterial pneumonia (BP), and pulmonary tuberculosis (TB) in human immunodeficiency virus (HIV)-positive patients and to identify the frequency with which these infections mimic one another radiographically. The admitting CXRs of 153 HIV-positive patients with laboratory proven BP (n = 71), PCP (n = 73), and TB (n = 9) and those of 10 HIV-positive patients with no active disease were reviewed retrospectively and independently by three radiologists who were blinded to clinical and laboratory data. Median percent accuracies were as follows: TB, 84%; PCP, 75%; BP, 64%; and no active disease, 100%. Fifteen of 153 cases (9.8%) were shown to mimic other infections radiographically. A confident and accurate diagnosis can be made radiographically in the majority of cases of PCP, BP, and TB in HIV-positive patients at the time of hospitalization. In approximately 10% of cases, these infections may mimic one another radiographically.

Surgical biopsy findings in patients with atypical hyperplasia diagnosed by stereotaxic core needle biopsy

AbstractPurpose: To correlate the stereotaxic core needle biopsy results with those of surgical biopsy in patients with atypical lobular or ductal hyperplasia (atypical hyperplasia) diagnosed at stereotaxic core needle biopsy (SCNB). Methods: We retrospectively reviewed the mammograms and pathology reports of 358 consecutive SCNBs performed in 323 patients. The results of SCNBs of 22 lesions reported as atypical hyperplasia were correlated with histologic findings at surgical biopsy. Results: A histologic diagnosis of atypical hyperplasia at SCNB was found to be a poor predictor of the final surgical results. In the 19 patients with 22 lesions, surgical biopsy and SCNB results were in disagreement in 16, partial agreement in two, and complete agreement in only four lesions. Furthermore, five cases of atypical hyperplasia were shown to have invasive carcinoma on open biopsy, and five had ductal carcinoma in situ in the surgical biopsy, none of which was present on SCNB. Conclusion: Given the frequent occurrence of malignancy in patients diagnosed with atypical hyperplasia by SCNB, it is recommended that all such patients undergo excisional biopsy.

Voice-activated retrieval of mammography reference images

We undertook this project to integrate context sensitive computer-based educational and decision making aids into the film interpretation and reporting process, and to determine the clinical utility of this method as a guide for further system development. An image database of 347 digital mammography images was assembled and image features were coded. An interface was developed to a computerized speech recognition radiology reporting system which was modified to translate reported findings into database search terms. These observations were used to formulate database search strategies which not only retrieved similar cases from the image database, but also other cases that were related to the index case in different ways. The search results were organized into image sets intended to address common questions that arise during image interpretation. An evaluation of the clinical utility of this method was performed as a guide for further system development. We found that voice dictation of prototypical mammographic cases resulted in automatic retrieval of reference images. The retrieved images were organized into sets matching findings, diagnostic hypotheses, diagnosis, spectrum of findings or diagnoses, closest match to dictated case, or user specified parameters. Two mammographers graded the clinical utility of each form of system output. We concluded that case specific and problem specific image sets may be automatically generated from spoken case dictation. A potentially large number of retrieved images may be divided into subsets which anticipate common clinical problems. This automatic method of context sensitive image retrieval may provide a “continuous’; form of education integrated into routine case interpretation.

Pneumothorax in patients with acute respiratory distress syndrome: pathophysiology, detection, and treatment.

Pneumothorax is a frequent and potentially fatal complication of mechanical ventilation in patients with acute respiratory distress syndrome (ARDS). Prompt recognition and treatment of pneumothoraces is necessary to minimize morbidity and mortality. The radiologic and clinical signs of pneumothoraces in ARDS patients may have unusual and subtle features. Furthermore, small pneumothoraces in these patients can cause severe hemodynamic or pulmonary compromise. Sparse clinical literature exists on when or how to treat pneumothoraces once they develop in patients with ARDS. In this article, the authors review the pathogenesis, radiologic signs, clinical significance, and treatment of pneumothoraces in ARDS patients. Treatment options include traditional tube thoracostomy, open thoracotomy, and image-guided percutaneous catheters.

Mediastinal trauma and other acute mediastinal conditions

Acute mediastinal diseases most often result from penetrating or blunt trauma and from iatrogenic injuries related to the misplacement of tubes and catheters. The commonest chest film findings of mediastinal disease include mediastinal contour alteration, such as obliteration of normal structures mediastinal widening, and pneumomediastinum. Characteristic mediastinal findings injury to specific mediastinal structures are presented.

Pulmonary Edema and the Adult Respiratory Distress Syndrome

Pulmonary edema contributes to several disorders that cause acute respiratory failure. Edema may be the main pathological feature, as in congestive heart failure (CHF), or contribute to a more complex process, such as the adult respiratory distress syndrome (ARDS).

The Intensive Care Chest

Patients with diffuse lung disease are among the most desperately ill in the Intensive Care Unit (ICU). Clinicians caring for these patients must be adept at evaluating and treating disorders associated with high morbidity and mortality. These disorders may precipitate admission to the ICU or complicate other processes.