Widening of the subcarinal angle by pericardial effusion

The subcarinal angle and transverse diameter of the cardiopericardial silhouette were measured on inspiratory posteroanterior radiographs of 54 patients (average age, 43.1 years) with pericardial effusion. The subcarinal angle was significantly greater (p less than 0.001) during effusion (81.0 degrees, n = 54) than either before (62.3 degrees, n = 14) or after (56.7 degrees, n = 21) effusion. A significant (p less than 0.05) positive correlation (r = 0.60, n = 118) was found between the magnitude of the subcarinal angle and the transverse diameter. This suggested that pericardial fluid accumulation displaces the heart and, in turn, splays the main bronchi. When pericardial fluid is not suspected clinically, a widened subcarinal angle, without other evidence of left atrial enlargement, may be a clue suggesting pericardial effusion.

Clinical and virologic studies on female genital herpes

Ninety women with genital herpes were studied clinically and virologically. From a clinical standpoint, these patients could be classified into 3 clinical types--acute, recurrent, and provoked. When herpes simplex virus (HSV) strains isolated from these patients and asymptomatic virus secretors were typed, 36 strains were determined to be type 1 (HSV-1) and the remaining 54 to be type 2 (HSV-2). The acute type was caused by primary infection of HSV-1 or HSV-2 as well as by infection of HSV-2 in the absence of heterologous antibody. In addition, 35 of 40 HSV strains isolated from recurrent, provoked, and asymptomatic virus secretors were identified as HSV-2, suggesting that HSV-2 may play a major role in establishing latent infection in the female genital region.

Chest roentgenographic evaluation of the severity of aortic stenosis

The chest radiographs of 44 adult patients with proven valvular aortic stenosis (AS) were analyzed for the evaluation of severity of the disease. Five parameters were correlated with the aortic valve area (AVA) as the determinant of AS severity: the area of aortic valve calcification (AVCa), the cardio--thoracic (C--T) ratio, the Hoffman-Rigler (H-R) sign, left atrial enlargement (LAE), and the transverse diameter of the thoracic aorta (TDAo). There was a significant correlation between AVCa and severe AS only in women over 40 years of age. The increased C--T ratio and evidence of LAE was predictive of severe AS in men over 40 years of age. The positive H-R sign and an increased TDAo were not useful in assessing the severity of AS. Accordingly, the radiographic analysis of signs is a simple, useful, and noninvasive technique for diagnosing AS and for assessing its severity in patients over 40 years of age.

Postpericardiotomy syndrome

Postpericardiotomy syndrome is an immune phenomenon that occurs from several days to months after surgical incision of the pericardium. Prominent clinical features include fever, pericarditis, and pleuritis. Of 161 patients with Wolff-Parkinson-White syndrome who underwent surgical treatment, 50 (31%) developed postpericardiotomy syndrome 4-12 days later. Of these 50 patients, 38 had sufficiently complete records for analysis. Significant radiographic abnormalities were present in 30 (79%) of these 38 patients, pericardial effusions in 19 (50%), pleural effusions in 26 (68%), and pulmonary infiltrates in four (10%). These radiographic signs almost always developed within 2 days of the onset of symptoms, either before or after, and were essentially absent in the 76 patients who did not clinically develop the syndrome. Postoperative radiographs can be extremely valuable in first suggesting or confirming the suspicion of postpericardiotomy syndrome.

Calcification in pulmonary metastases

A large variety of neoplasms can produce calcified lung metastases. Three unusual examples are presented and the relevant literature is reviewed. Each case involves a neoplasm not previously reported to produce calcified lung metastases: malignant mesenchymoma, fibrosarcoma of the breast, and medullary carcinoma of the thyroid. The sarcomas are reported in the literature to develop calcified lung metastases are osteogenic sarcoma, chondrosarcoma, synovial sarcoma, and giant cell tumour. Among carcinomas, the papillary and mucinous adenocarcinomas are the histological types most likely to develop calcified lung metastases. The metastases of a number of other tumours have calcified after antineoplastic therapy. Calcification in metastases arises through a variety of mechanisms: bone formation in tumour osteoid, calcification and ossification of tumour cartilage, dystrophic calcification and ossification of tumour cartilage, dystrophic calcification and mucoid calcification. Since calcified lung metastases can strongly resemble granulomas or hamartomas, a reasonable suspicion of malignancy is necessary when evaluating calcified pulmonary nodules.

Metastatic melanoma in the thorax: report of 130 patients

Early detection of metastatic melanoma has become more important as newer and more effective therapeutic regimens are used. Between 1970 and 1980, 1,600 patients were treated at one institution for malignant melanoma. Of these, 260 (16.3%) developed thoracic metastasis. Satisfactory chest radiographs were available for analysis in 130 of 260 patients. The patterns of the intrathoracic metastasis include multiple pulmonary nodules (52 patients), solitary nodule (26), miliary pattern (two), mediastinal and/or hilar adenopathy (nine), pleural effusion (three), lytic bony lesions (one), extra-pleural mass (one), and combined lesions (36). Both the staging of melanoma and the radiographic pattern of thoracic metastasis seemed to prognosticate the survival rate of these patients. Miliary metastasis and bone destruction implied a grave prognosis. Patients with a solitary lung nodule had the best survival experience. Immunotherapy, chemotherapy, and surgery of selected distal metastases significantly improved the survival of most of these patients.

Massive calcification of the mitral annulus in a 17-year-old patient with juvenile rheumatoid arthritis and systemic lupus erythematosis

Mitral annulus calcification (MAC), while a relatively frequent autopsy finding in older patients, is rare in childhood. Such calcification has generally been regarded as a degenerative change and of no clinical significance. Recent studies have shown that MAC may be associated with hemodynamically significant lesions including mitral insufficiency, arrhythmias, heart block, and, rarely, mitral stenosis. We have studied a case of massive calcification in the mitral annulus in a 17-year-old girl with juvenile rheumatoid arthritis and systemic lupus erythematosis. In this case, the MAC was considered secondary to the rheumatoid disease. MAC in younger patients with no history of rheumatic fever or bacterial endocarditis suggests an associated connective tissue disorder.

Coronary sinus atrial pacing: radiographic considerations

Transvenous atrial pacing via an electrode placed in the coronary sinus has become an increasingly frequent procedure during the past 10 years for both diagnosis and therapy of cardiac arrhythmias. The coronary sinus has five major venous tributaries, any one of which can be entered by a pacing catheter. A catheter in the middle cardiac vein can mimic the usual ventricular pacemaker position, while an electrode in the coronary sinus or in a persistent left superior vena cava may be mistaken for myocardial perforation. A persistent left superior vena cava may also be catheterized. This anomaly is associated with a tenfold increased incidence of congenital atrioventricular conduction abnormalities and, therefore, is surprisingly common in patients having coronary sinus pacers placed because of cardiac arrhythmias.

The diagnostic and prognostic significance of coronary artery calcification. A report of 800 cases

The significance of coronary artery calcification was assessed in 800 patients who underwent cardiac fluoroscopy and selective coronary cineangiography. Calcification was shown by fluoroscopy in 250, of whom 236 (94%) had greater than or equal to 75% stenosis of one or more major coronary arteries at angiography. Among patients with significant coronary artery disease, 40% (236/585) had calcification. Patients with calcification demonstrated poorer survival at all follow-up intervals (from six months to five years); the five-year survival rate was 87% for patients without calcification, compared to 58% for those with calcification. The prognostic significance of coronary artery calcification appears to be independent of information obtained by cardiac catheterization and angiocardiography.

Radiologic demonstration of anomalous pulmonary venous connection and its clinical significance

1. As surgical techniques continue to improve, early diagnosis and early surgical intervention of APVCs become increasingly important. 2. For a thorough understanding of APVCs, normal development of the pulmonary veins and the embryological basis of these anomalies are briefly reviewed. 3. Radiologic signs and clinical implications of varying types of APVCs are illustrated. 4. TAPVCs are less frequent, but clinically more significant, than PAPVCs. 5. The symptomatology of TAPVC is directly related to (1) the degree of pulmonary venous obstruction, (2) the severity of CHF secondary to volume overload, and (3) the magnitude of pulmonary hypertension. Patients with PAPVC become symptomatic only when the left to right shunt is greater than 50%9 6. TAPVC to the LVV produces a pretracheal density on the lateral view prior to the appearance of snowman configuration on the postero-anterior view. TAPVC to the PV shows a combination of severe pulmonary edema and a normal-sized heart. 7. PAPVC may be diagnosed by visualization of the anomalous vein(s) in addition to the usual signs of an ASD (increased pulmonary blood flow plus right-sided cardiomegaly). 8. PAPVC is usually associated with an ASD. Scimitar syndrome is an exception to the rule. 9. The surgical repair of TAPV without obstruction is generally relatively simple because of the strong tendency for all of the pulmonary veins to converage into a common chamger. Emergency operation is the only hope for patients with TAPVC with obstruction. 10. The surgical treatment of PAPVC consists of reconstruction of the atrial septum; thus, the anomalous veins can be diverted into the left atrium. 11. Surgical correction of PAPVC prevents detrimental resection of the lung with normal pulmonary venous connection.

Tetralogy of Fallot associated with uncommon lesions

A patient presented with a a unique combination of cardiovascular abnormalities: tetralogy of Fallot, absent pulmonary valve, stenosis of peripheral pulmonary arteries, and partial anomalous pulmonary venous connection to the azygos vein. The salient aspects and associated lesion of each of these abnormalities are described.

X-ray appearance and clinical significance of left atrial wall calcification

Ten patients with calcifications of the left atrium are reported with review of the literature. Calcification of the left atrium is frequently associated with history of rheumatic fever, longstanding congestive heart failure, atrial fibrillation, mural thrombus and embolization. Early recognition of such lesions is essential for the management of the patients, particularly when surgical intervention is contemplated. A practical classification of left atrial calcification is proposed according to the dominant lesion in each group: (a) Calcification of the left atrial appendage alone (Mitral stenosis). (b) cacification of all 3 component lesions of the left atrium, i.e., the left atrial appendage, the free wall, and the mitral valve (Severe mitral stenosis). (c) Calcification of the left atrium in MacCallum's patch alone (Mitral insufficiency).

Infrared studies of the dynamic aspects of hydrogen-bonding in hydroxylated metabolites of 2,5,2',5'-tetrachlorobiphenyl

Infrared spectral studies indicate that the hydroxylated 2,5,2',5'-tetrachlorobiphenyls (TCBs) exist in a dynamic equilibrium of free, intramolecular, and intermolecular hydrogen-bonded forms. The relative abundances of the various species depend upon the polarity of the solvents as well as the physical state of the compound resulting from different configurations, i.e., the monohydroxylated 2,5,2',5'-TCBs exist as cis and trans rotational isomers of OH with respect to the chlorine atom in the ortho position, and 3,4-dihydro-3,4-dihydroxy-2,5,2',5'-TCB exists as 2 trans conformers with the OH groups either axial-axial or equatorial-equatorial with respect to the plane of the attached ring. In the solid state, the dimer or polymer is preferred with intermolecular hydrogen-bonding occurring between OH groups.