RESUMEN
Bronchopulmonary foregut malformations encompass a great variety of anomalies that may arise from abnormal differentiation of the respiratory and alimentary tracts, abnormal separation of the two systems, or abnormal development of blood supply, perhaps singly or in combination, during early embryogenesis. The pulmonary and neurenteric forms share the common features of a pulmonary parenchymal opacification and/or intrathoracic mass, with the addition of vertebral anomalies in the instance of the neurenteric malformations. Plain radiographs serve as the starting point for diagnostic evaluation and sometimes are all that is needed; more often, though, the plain film findings suggest which road to follow in further imaging. No single imaging approach can be advocated for all patients. The lesion may be found initially, for example, on prenatal sonography. Ultrasonography also can establish the cystic nature of a mass and may help define vascular supply, although it cannot yet be said to have supplanted angiography's role in evaluating suspected sequestrations. For most intramediastinal or intrapulmonary masses without associated vertebral anomalies, CT will satisfactorily establish the cystic nature and should afford a reasonably confident preoperative diagnosis of bronchogenic cysts or type 1 or 2 cystic adenomatoid malformations. Type 3 cystic adenomatoid malformation, because of its relatively "solid" imaging characteristics, may not be diagnosed confidently by preoperative imaging. The finding of vertebral anomalies associated with a mediastinal mass especially warrants MR imaging to define intraspinal involvement. However, the association of vertebral or rib anomalies with apparent unilateral pulmonary agenesis or hypoplasia arouses suspicion of a bronchopulmonary foregut malformation that communicates with the gastrointestinal tract, and this uncommon situation calls for a barium examination. Radionuclide scintigraphy has an ancillary role in assessing foregut anomalies, but many findings from scintigraphy are relatively nonspecific and anatomic definition is poor. Scintigraphy may yield supportive information in cases of sequestration that have inconclusive findings as determined by plain radiographs and CT.
Asunto(s)
Quiste Broncogénico/diagnóstico , Secuestro Broncopulmonar/diagnóstico , Malformación Adenomatoide Quística Congénita del Pulmón/diagnóstico , Quiste Mediastínico/diagnóstico , Quiste Broncogénico/diagnóstico por imagen , Secuestro Broncopulmonar/diagnóstico por imagen , Malformación Adenomatoide Quística Congénita del Pulmón/diagnóstico por imagen , Humanos , Quiste Mediastínico/diagnóstico por imagen , Radiografía , Cintigrafía , UltrasonografíaRESUMEN
A rare cause of superior mediastinal widening from traumatic extravasation of cerebrospinal fluid is reported in two children following automobile accidents. Radiographic findings include widened superior mediastinum evolving during the immediate posttrauma phase, pleural effusion, and CSF leak into the superior mediastinum on metrizamide CT myelogram. Both children had neurologic deficits of the lower extremities.
Asunto(s)
Líquido Cefalorraquídeo/fisiología , Mediastino/patología , Preescolar , Duramadre/lesiones , Femenino , Humanos , Masculino , Mediastino/diagnóstico por imagen , MielografíaRESUMEN
We retrospectively investigated the relationship between left ventricular ejection fraction (EF) and end diastolic cross sectional area (DCS), by means of gated cardiac blood pool studies, in 62 individuals (68 studies) who were of age 85 y or older. In these "oldest old", a plot of log ejection fraction as a function of log cross sectional area revealed good correlation (r = 0.66). The graph demonstrated the increase in heart size with a falling ejection fraction. Of the "oldest old", 38% had EF values at or above 55%. By comparison, in a group of 100 patients of ages 55-75 y, 32% had EF values of or above 55%. In the "oldest old" 13/68 (19%) had "hyperdynamic" EF values over 65%; in the 55-75 y old group, this value was 16%. The log-log plot was divided into four quadrants by two lines (one at a DCS of 26 cm2 and the other at EF of 55%). Possible prognostic significance of each of these four categories will have to be determined by following the patients and sorting out the contributions of such factors as hypertension, coronary artery disease and medications.