Radiologic clinics of North America
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Radiol. Clin. North Am. · May 1990
ReviewRadiographic manifestations of primary bronchogenic carcinoma.
Carcinoma of the lung continues to account for more cancer-related deaths than any other neoplasm in the United States. The World Health Organization recognizes four main classifications of cell type. Squamous cell carcinoma is most often a central lesion that locally invades the hilus and mediastinum. ⋯ Small cell carcinoma is the most aggressive of the four cell types, having the worst prognosis. The classic presentation is the detection of hilar and mediastinal metastases while the primary tumor remains occult. Grossly enlarged hilar and mediastinal lymph nodes can be seen easily on chest radiograph and CT scan.
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Nonlymphomatous pulmonary lymphoproliferative disorders include plasma cell granuloma, Castleman's disease, pseudolymphoma, lymphocytic interstitial pneumonitis, angioimmunoblastic lymphadenopathy, and lymphomatoid granulomatosis. They are thought to represent a hyperplasia of the pulmonary immune system in response to chronic antigenic stimulation. A description of the variable clinical, radiographic, and pathologic features of each entity is presented.
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Scintigraphic techniques play an important role in the diagnosis and evaluation of a wide variety of musculoskeletal injuries. They provide physiologic and pathophysiologic information but do not provide the exquisite resolution of computed tomography or magnetic resonance imaging. Thus, scintigraphy studies should be ordered only when they would be expected to provide data that will establish a diagnosis or help in planning therapy.
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The radiologic evaluation of upper extremity trauma relies primarily on standard as well as optional radiographic projections. Certain injuries are more fully evaluated with fluoroscopy, arthrography, ultrasound, computed tomography, or magnetic resonance imaging. The imaging approach to upper extremity trauma is presented, with emphasis on subtle or commonly overlooked lesions. The indications for evaluation by fluoroscopy, arthrography, and advanced imaging modalities are discussed.
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Imaging of patients with pelvic trauma begins with a logical approach to plain radiographs. These films reveal the probable mechanism of injury and suggest a rationale for emergent reduction. Radiographs, along with the clinical impression, suggest the likelihood of associated soft tissue injury, possibly requiring further specific radiographic studies. ⋯ When multiple ribs are fractured in two places, the radiologist should suggest the possibility of flail chest. Sternal fractures and multiple rib fractures, including the first three ribs, may herald life-threatening vascular or cardiac damage. To summarize, the radiologist contributes most to the care of the trauma patient by recognizing roentgen patterns of injury, knowing which are commonly accompanied by damage to critical soft tissues, and performing the indicated radiographic studies efficiently.