J H Woodring

Pulmonary tuberculosis produces a broad spectrum of radiographic abnormalities. During the primary phase of the disease these include pulmonary consolidation (50%), which often involves the middle or lower lobes or the anterior segment of an upper lobe; cavitation (29%) or pneumatocele formation (12%); segmental or lobar atelectasis (18%); pleural effusion (24%); hilar and mediastinal lymphadenopathy (35%); disseminated miliary disease (6%); and a normal chest radiograph (15%). During the postprimary phase of the disease, common abnormalities include exudative and/or fibroproductive parenchymal densities (100%), predominantly in the apical and posterior segments of the upper lobes (91%); cavitation (45%) with bronchogenic spread of disease (21%); marked fibrotic response in the lungs (29%); and pleural effusion, empyema, and fibrosis (18%, 4%, and 41%, respectively). Upper-lobe masslike lesions are seen occasionally (7%); spontaneous pneumothorax and intrathoracic lymphadenopathy are rare (5% each). Common causes of a missed diagnosis of tuberculosis are (1) failure to recognize hilar and mediastinal lymphadenopathy as a manifestation of primary disease in adults, (2) exclusion of tuberculosis because disease predominates in or is limited to the anterior segment of an upper lobe or the basilar segment of a lower lobe, (3) overlooking of minimal fibroproductive lesions or reporting them as inactive, (4) failure to recognize that an upper-lobe mass surrounded by satellite fibroproductive lesions might be tuberculous, and (5) failure to consider healed sequelae of primary disease or a positive purified protein derivative skin test as contributory to identifying the patient's pulmonary disease.

Sixty-five solitary cavities of the lung were evaluated for wall thickness. All lesions in which the thickest part of the cavity wall was 1 mm were benign. Of the lesions whose thickest measurement was 4 mm or less, 92% were benign. Of cavities that were 5-15 mm in their thickest part, 51% were benign and 49% malignant. Of those over 15 mm thick, 95% were malignant. Measurement of the thickest part of te cavity wall gives a more reliable indication of benignancy or malignancy than measurement of the thinnest part.

Significance of wall thickness in solitary cavities of the lung: a follow-up studyJH Woodring and AM FriedAudio Available | Share

The diagnosis of traumatic atlantooccipital dislocation (AOD) from the cross-table lateral radiograph is difficult because of problems in demonstrating the complex anatomy of this area and the intricate radiographic methods used to diagnose AOD. Although CT or polytomography seem to be the most accurate diagnostic methods, it is often the lateral radiograph from which the diagnosis and further decisions are made. To determine both the best radiographic method for diagnosing AOD from the lateral radiograph and the role of CT and tomography in the diagnosis of AOD, the literature was reviewed concerning how the diagnosis of AOD has been obtained. In addition, the Wholey dens-basion line, the Powers ratio, the Dublin method of diagnosing AOD, and measurement of the atlantooccipital joint width were applied to 12 cases of traumatic AOD; and the Wholey dens-basion line and the Powers ratio were determined in 100 normal adults and 50 normal children. An alternative plain radiographic method for diagnosing AOD was developed, called the X-line method. This was the most accurate of the methods tested, correctly diagnosing AOD in 75% of cases. The Wholey dens-basion line and direct measurement of the atlantooccipital joint width were each correct in 50% of cases, the Powers ratio in 33% of cases, and the Dublin method in only 25% of cases. Ultimately, either CT or polytomography should provide the definitive diagnosis. In this regard high-resolution CT with reformatted coronal and sagittal images generated from 2-mm thin axial slices appeared to have the most promise as the first study of choice.

A prospective analysis of supine radiographs in 40 patients with pleural effusions was undertaken to determine the radiographic manifestations of pleural effusion on supine radiographs and the quantity of fluid that may be detected in the supine position. The presence of pleural effusion was predicted from supine radiographs using the following signs: increased homogeneous density superimposed over the lung fields, obliteration of the silhouette of the diaphragm, meniscus sign, apical capping, and accentuation of the right minor fissure. The supine radiographic findings were correlated with findings on subsequent standing erect posteroanterior and lateral radiographs. This study indicates that effusion of sufficient quantity to produce blunting of the lateral costophrenic angle on an erect posteroanterior radiograph (175-525 ml) will produce a noticeable increase in the density of the lower lung zone on supine radiographs. As the quantity of effusion increases, the abnormality of the supine chest radiograph increases in a stepwise manner. The classical findings of increased density over the entire hemithorax and apical capping described in pleural effusion on supine radiographs are late findings seen typically in large effusions.