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Practicing thoracic surgeons were randomly surveyed to evaluate how computed tomography (CT) has influenced the preoperative evaluation of bronchogenic carcinoma. Thirty-six percent of the 529 respondents routinely requested CT and 62% did so selectively. Approximately 40% indicated that CT provided useful information in most cases. Nearly all surgeons (98.7%) do not rely on the identification of enlarged lymph nodes with CT to spare the patient surgical staging; however, 77.5% are influenced by CT results in their staging procedures. Fifty-seven percent reported that a negative CT study eliminates surgical staging entirely unless the patient has a "coin lesion," in which case 75% are willing to proceed directly to thoracotomy. For surgeons who use CT selectively, an abnormal mediastinal contour on the radiograph was the most frequent radiologic abnormality to prompt CT (85%). Thirty-seven percent are influenced by tumor histology in their decision to request CT. There was little difference in the pattern of CT use between university and community hospital surgeons.

The air crescent sign is regarded as an important diagnostic finding in invasive pulmonary aspergillosis (IPA). This study examined the incidence, clinical importance, and natural history of air crescents in 25 patients with acute leukemia and IPA. Twelve (50%) of the patients had cavities (ten with an air crescent) that appeared an average of 15 days after the initial infiltrate. The diagnostic utility of the air crescent sign was relatively minor; cavities developed after the diagnosis was established in 50% of cases and after therapy was started in 75% of cases. In each case, the pneumonia improved at the time of cavitation. In six patients (50%), the cavities resolved over 2-8 months. Three patients (25%), however, experienced massive hemoptysis. Air crescent formation, previously shown to be dependent on granulocyte recovery, was associated with improved survival (67%) compared with the group without cavitation (8%). In the latter group, the pneumonia in ten (77%) of 13 patients progressed to diffuse disease. In patients with leukemia, the diagnostic value of the air crescent sign is limited by cavities that develop relatively late, as the infection improves after white blood cell recovery; cavities that do not occur in patients who remain neutropenic; and associated hemorrhage, at times life-threatening, that obscures the air crescent. The diagnosis of IPA should not await observation of air crescents in these patients.

Acute gastrointestinal vasculitis is a recognized but frequently misdiagnosed complication of systemic lupus erythematosus. Of 141 patients with SLE, 20 had ischemic disease reversible in all cases with steroid therapy. Nine patients had radiographic findings consistent with vasculitis such as pseudo–obstruction of the gastric outlet, duodenal stasis, effacement of mucosal folds, spasticity and thumbprinting. Lupus gastrointestinal vasculitis is a rnore common entity than generally recognized. Careful evaluation of the abdominal plain film or gastrointestinal series helps to establish the diagnosis of vasculitis.

The hypereosinophilic syndrome is a spectrum of clinical disorders characterized by leukocytosis and marked eosinophilia without definable cause. Clinical symptoms and radiographic findings are most often due to congestive heart failure, although parenchymal lung infiltrates from the eosinophilia itself may be seen. Four documented cases with chest radiographs are presented.

Recurrent infiltrates and shadows of mucold impaction are typical radiographic features of allergic bronchopulmonary aspergillosis (ABPA). In 14 cases seen by the authors, atelectasis (46%) and chronic consolidation, at times accompanied by cavitation (21%), were other dominant features of this hypersensitivity disorder and may suggest the diagnosis in the appropriate clinical setting. Mycetoma, empyema, and spontaneous pneumothorax were unusual complications. Radiologists should be familiar with the wide range of findings in ABPA, since early diagnosis and steroid therapy are important.

Five patients with chronic traumatic diaphragmatic hernia presented with symptoms of acute intestinal obstruction and unilateral pleural effusion. In each case, infarcted herniated abdominal structures were found at surgery. The presence of an ipsilateral pleural effusion is an important radiographic sign, which may indicate strangulation in patients with chronic traumatic diaphragmatic hernia.

Diffuse pulmonary hemorrhage is an uncommon condition that is difficult to differentiate radiographically from diffuse pneumonia or pulmonary edema. The diagnosis should be suspected when a patient has even mild hemoptysis or has one of the diseases known to be associated with diffuse pulmonary hemorrhage. This paper reviews the clinical and radiographic features of diffuse pulmonary hemorrhage and presents a classification scheme depicted as a Venn diagram formed by four overlapping circles representing pulmonary hemorrhage, renal disease, immune complex disease, and antiglomerular basement membrane (anti-GBM) disease. This scheme results in six categories of pulmonary hemorrhage: associated with glomerulonephritis and anti-GBM antibody; associated with renal disease without demonstrable immunologic abnormalities; associated with glomerulonephritis and immune complex disease; associated with immune complex disease without renal disease; associated with anti-GBM antibodies without renal disease; without associated immunologic or renal abnormality. Examples of these disorders are illustrated. Improved clinical-radiographic correlation may lead to earlier diagnosis and treatment of diffuse pulmonary hemorrhage and its causes.

Of 141 cases of plasma-cell myeloma, 24 cases (17%) presented as nonosseous, the largest number of such cases in a single series in the literature. This points to the importance of early soft-tissue and organ involvement in the disease prior to bone involvement. The varied modes of presentation are discussed.

Two cases of pigmented villonodular synovitis of the temperomandibular joint are reported. The diagnosis was not considered originally in either case and this entity has never been previously reported in this location. Smooth destruction of adjacent bone was encountered in both cases. Differential diagnosis including carcinoma of the external auditory canal and middle ear as well as other, less likely possibilities, are discussed.

The authors report 2 cases of gangrene of the colon in which abdominal plain films suggested toxic megacolon. Barium enema examination demonstrated colonic distension with marked mucosal loss. The authors emphasize the importance of careful clinical and radiological follow-up in patients with “transient” ischemic colitis, since such patients may progress to gangrene of the colon.

Pneumothorax is an unusual manifestation of Wegener granulomatosis. Two cases are presented which illustrate a definite association between the entities. Pneumothorax may be the initial and only pulmonary manifestation, or it may occur in combination with other evidence of the disease.

A case of achalasia complicated by Mycobacterium fortuitum pulmonary infection and empyema is reported. This association has been documented in the medical literature. Possible mechanisms explaining this association are discussed.