[The right postpneumonectomy syndrome]

Two patients with a so-called right-sided postpneumonectomy syndrome are described. The syndrome results from a marked mediastinal shift towards the vacant hemithorax, primarily after a pneumonectomy performed in early childhood. The trachea is compressed by the aortic arch and distorted by the mediastinal shift. The left main bronchus is compressed between the left central pulmonary artery and the descending aorta. This can result in tracheobronchomalacia and recurrent pneumonia in the remaining lung.

[Roentgen pathology of blunt bronchial injuries]

We present eight patients with bronchial injuries. The pertinent radiographic findings were subdivided into: (1) signs pertinent to the bronchial tree; (2) signs due to airleak; (3) signs made in the subtended lung. The radiologist plays an important role in the early diagnosis of this severe injury.

[CT diagnosis of cystic hygroma]

We present five patients with cystic hygroma: the CT features are presented. It occurs primarily in the region of the neck. Occasional involvement of the axilla, the chest wall and the mediastinum is possible.

The sensitivity of plain films for detecting perforation in children with appendicitis

The plain films of 37 patients under age 18 with surgically and pathologically proven non perforated (16/37) and ruptured (21/37) appendicitis were reviewed in order to determine the ability of the plain film to specify perforation. Perforation was suggested when one or more of the following six findings were clearly defined: 1. Acute small bowel obstruction. 2. Extraluminal gas. 3. Mass in the right lower quadrant. 4. Colon cut-off sign at the hepatic flexure. 5. Fecalith. 6. Obliteration of the pelvic fat planes. This approach resulted in a sensitivity of 80% and a specificity of 94%, with the only false positive for perforation occurring in a patient with a fecalith. In five patients, extraluminal gas produced a triangular accumulation in the right flank which could be distinguished from intraluminal bowel gas on the supine or prone film.

Solitary pulmonary granuloma with marked enhancement on dynamic CT scanning

A patient is described who presented with a vividly enhancing solitary pulmonary nodule during dynamic CT scanning. This mass proved to represent a granuloma due to coccidioidomycosis. The presumptive mechanism of enhancement as well as the differential diagnosis are discussed.

Hinged shutter for image alternator

A hinged, mobile shutter was designed to reduce the effect of extraneous light on the interpretion of chest radiographs and angiograms. The authors believe that the device greatly facilitates the daily work by decreasing eye fatigue and probably by increasing the signal-to-noise ratio.

[Pulmonary parenchymal and pleural fibrosis as an expression of Recklinghausen's neurofibromatosis]

We report three patients with neurofibromatosis, lung parenchymal, and pleural changes. Lung fibrosis occurs in 10% of patients with neurofibromatosis. Pleural involvement is less common. We are presenting one such case.

Episternal ossicles

Eight hundred computed tomographic (CT) scans of the chest were reviewed, and 12 cases of episternal ossicles were found. Eight persons had paired ossicles, and four had unilateral ossicles. The overall frequency in the study population was 1.5% (men, 1.4%; women, 1.7%). Episternal ossicles represent a normal variant and should be distinguished from fracture fragments, sequestra, foreign bodies, calcified lymph nodes, or vascular calcifications.

Traumatic rupture of the thoracic aorta. A review of 49 cases

We examined retrospectively the chest radiograph of forty nine patients with angiographically proven aortic ruptures. The plain film findings found most consistently were a wide mediastinum (69.5%), partial obliteration of the descending aorta (67.3%), left apical cap (65.3%), downward displacement of the left main bronchus (65.3%), tracheal deviation to the right (63.2%), obscuration of the aortic arch (55.1%), right paratracheal stripe thickening (53%) and nasogastric tube deviation to the right (50%). We also examined 113 sequential aortograms performed after thoracic trauma over 3 years, to determine the positive rate in our series; 14 studies were positive for a rate of 12.4%. No single case of proved ruptured aorta with a normal chest radiograph was detected.

CT-findings in ARDS

The CT features of 28 patients with ARDS are described. Diffuse lung consolidation, multifocal patchy involvement and lobar or segmental disease were observed. Large lung cysts as well as small cysts producing a "swiss-cheese" appearance of the parenchyma, were detected. These findings were not regularly appreciated on chest radiographs. The overall mortality of our 28 patients was 72.7% (22 out of 28). Patients with lung cysts showed a trend toward higher mortality (87.5% or 13 out of 16). Other unexpected findings were basilar lung abscesses and an empyema. In 15 out of 28 patients, CT scans provided additional information, not obvious on bedside chest radiographs and led to a change in management in five patients.

Pulmonary arterial hypertension as a manifestation of lupus erythematosus

We present five patients with systemic lupus erythematosus (SLE) who developed pulmonary arterial hypertension and cor pulmonale in the course of their disease. The clinical features, as well as, the radiological manifestations of this rare manifestation of SLE are discussed. A vasculitic process is the most likely cause of this complication. Therapy is ineffective and the prognosis is poor.