[Evaluation of the chest roentgenograms of 90 workers employed in the production of silicon-alloys (author's transl)].
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SUMMARY A prospective study was performed to evaluate the usefulness of CT pelvic venography (CTV) in the detection of pelvic vein thrombosis in patients referred for CT pulmonary angiography (CTPA) for suspected pulmonary embolism. Fifty consecutive patients referred for CTPA had CTV performed at the time of CTPA. All patients had duplex ultrasound (DUS) of the lower limb veins for evaluation of deep venous thrombosis (DVT) within 24 h of the CT study. Twelve (24%) of the 50 patients had pulmonary embolism diagnosed on CTPA. Associated DVT was detected in six of these patients; two cases were detected by CTV alone, while one case was detected by both CTV and DUS. The remaining three cases had DVT diagnosed by DUS alone. In the 38 patients with a negative CTPA, three patients had venous thrombus diagnosed by CTV. Of these three patients, two had a negative DUS study. CTV therefore led to a definitive imaging diagnosis of thrombo‐embolic disease in two (4%) more patients. CTV adds little time and cost to the CTPA examination and leads to a moderate increase in definite imaging diagnosis of thrombo‐embolic disease.
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The focus of this study was on the frequency of negative initial/subsequent ultrasound (US) of the lower extremities but positive spinal computed tomography contrast angiography (CTA) diagnostic of pulmonary embolism (PE) among 75 patients undergoing cervical laminectomy/fusion and 165 patients having lumbar laminectomy/noninstrumented fusion.To determine the percentage/incidence of patients undergoing spinal surgery with negative US but with positive CTA.The frequency of patients with negative US but with positive CTA after spinal surgery is not well documented.For 240 spinal surgery patients, postoperative prophylaxis against deep venous thrombosis consisted of alternating pneumatic compression stockings alone. The patients were routinely screened on postoperative days 1 to 2 for deep venous thrombosis using US. The incidence of initial/subsequent negative US and positive CTA diagnostic for PE in patients with mild/major symptoms was evaluated, in conjunction with the frequency of hypercoagulation syndromes.Five (6.7%) patients undergoing cervical surgery and 6 patients (3.6%) undergoing lumbar surgery exhibited negative US but positive CTA on postoperative days 1 to 21. All the patients immediately received inferior vena cava filters (2 permanent and 9 retrievable). Five patients (45%) tested positive for hypercoagulation syndromes. Two patients were fully anticoagulated on postoperative days 3 and 21 with major symptoms attributed to saddle emboli; 1 had hypercoagulation syndrome. Anticoagulation was delayed for 6 to 12 weeks in 7 patients with milder symptoms, as magnetic resonance imaging scans showed residual seromas; 4 had hypercoagulation syndromes. Two elderly patients, at high risk for falls, without hypercoagulation syndromes were not anticoagulated.The frequency of negative US of the lower extremities but with positive CTA for PE after 240 cervical/lumbar spinal procedures in patients with mild/major symptoms ranged from 3.6% to 6.7%; 5 of the 11 patients exhibited hypercoagulation syndromes. To avoid failure to diagnose PE after spinal surgery, one should have a "low threshold" (eg, based even on minor symptoms) for requesting the CTA.
Computed Tomography Angiography
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CT Venography (CTV) performed at the time of CT pulmonary angiography (CTPA) images the central, pelvic, and extremity venous circulation with minimal additional time, radiation, and no added contrast. CTV has been added to CTPA routinely at our Level I trauma center since 2000, and we sought to determine if this addition had increased the diagnostic yield of CTPA in trauma patients. The attending radiologist's interpretation of all CTPA-CTV studies performed over a 5-year period ending in August 2006 were retrospectively reviewed. CTPAs and CTVs were categorized as "positive", "negative", or "indeterminate" for pulmonary embolus (PE) and deep venous thrombosis (DVT). During the study period, 3798 patients underwent both a CTPA and CTV; 309 (8%) of these were trauma patients. Forty-four (14%) had a PE diagnosed on CTPA. Seventeen (6%) had a DVT diagnosed on CTV. In eight (3%), the CTV added clinically relevant data, diagnosing a DVT in a patient without PE. As the consequences of a missed pelvic DVT are high and the added time burden, radiation, and contrast required for a CTV are low, further investigation into optimizing the sensitivity of CTV performed at the time of CTPA is warranted.
Pulmonary angiography
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Computed Tomography Angiography
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The CT features of benign and malignant pleural diseases have been described. However, the accuracy of these features in the differential diagnosis of diffuse pleural disease has not been assessed before. Without knowledge of clinical or pathologic data, we reviewed the CT findings in 74 consecutive patients with proved diffuse pleural disease (39 malignant and 35 benign). The patients included 53 men and 21 women 23-78 years old. Features that were helpful in distinguishing malignant from benign pleural disease were (1) circumferential pleural thickening, (2) nodular pleural thickening, (3) parietal pleural thickening greater than 1 cm, and (4) mediastinal pleural involvement. The specificities of these findings were 100%, 94%, 94%, and 88%, respectively. The sensitivities were 41%, 51%, 36%, and 56%, respectively. Twenty-eight of 39 malignant cases (sensitivity, 72%; specificity, 83%) were identified correctly by the presence of one or more of these criteria. Malignant mesothelioma (n = 11) could not be reliably differentiated from pleural metastases (n = 24). We conclude that CT is helpful in the differential diagnosis of diffuse pleural disease, particularly in differentiation of malignant from benign conditions.
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Parietal Pleura
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Endobronchial ultrasound
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Objective:To analyze the complications of percutaneous transthoracic needle biopsy using CT-based imaging modalities for needle guidance in comparison with fluoroscopy in a large retrospective cohort.Materials and Methods: This study was approved by multiple Institutional Review Boards and the requirement for informed consent was waived.We retrospectively included 10568 biopsies from eight referral hospitals from 2010 through 2014.In univariate and multivariate logistic analyses, 3 CT-based guidance modalities (CT, CT fluoroscopy, and cone-beam CT) were compared with fluoroscopy in terms of the risk of pneumothorax, pneumothorax requiring chest tube insertion, and hemoptysis, with adjustment for other risk factors.Results: Pneumothorax occurred in 2298 of the 10568 biopsies (21.7%).Tube insertion was required after 316 biopsies (3.0%), and hemoptysis occurred in 550 cases (5.2%).In the multivariate analysis, pneumothorax was more frequently detected with CT {odds ratio (OR), 2.752 (95% confidence interval [CI], 2.325-3.258),p < 0.001}, CT fluoroscopy (OR, 1.440 [95% CI,, p < 0.001), and cone-beam CT (OR, 2.906 [95% CI,, p < 0.001), but no significant relationship was found for pneumothorax requiring chest tube insertion (p = 0.497, p = 0.222, and p = 0.216, respectively).The incidence of hemoptysis was significantly lower under CT (OR, 0.348 [95% CI,, p < 0.001), CT fluoroscopy (OR, 0.594 [95% CI, 0.419-0.843],p = 0.004), and cone-beam CT (OR, 0.479 [95% CI, 0.317-0.724],p < 0.001) guidance.Conclusion: Hemoptysis occurred less frequently with CT-based guidance modalities in comparison with fluoroscopy.Although pneumothorax requiring chest tube insertion showed a similar incidence, pneumothorax was more frequently detected using CT-based guidance modalities.
Univariate analysis
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