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A new sign of pneumomediastinum (mediastinal emphysema), namely a visible wall of a main bronchus as seen in the mediastinum on frontal radiographs of the chest, is described. This sign was present in eight out of 20 random cases of pneumomediastinum in adolescents and adults.

Conventional radiology is a routine examination in the diagnosis and management of cardiac diseases. A brief review of its value and limitations is given. A number of technical and/or physiological factors which may influence the cardiopulmonary configuration are mentioned. An approach is suggested for analysis of radiographs of the heart.

A short review is given of the anatomy of the pulmonary arterial system and of the bronchial arterial system. The normal vascular pattern of the lung as well as the altered vascular pattern under a number of abnormal circumstances is described.

A very brief review is given of the pathology of primary pulmonary tuberculosis. Numerous characteristic, but not pathognomonic, radiological appearances of primary pulmonary tuberculosis are briefly described and some of them are illustrated. The final diagnosis, however, depends on correlating the radiological picture with the clinical picture and special investigations.

Facilities for magnetic resonance imaging (MRI) have been available in South Africa since November 1985. This article summarizes our experience with this new imaging modality, illustrates normal anatomical features and pathological conditions in sagittal, coronal and axial planes, and compares MRI with computed tomography scans of the same regions.

An approach to the recognition of lesions on chest radiographs is outlined. Four basic groups of abnormalities by means of which lesions can be recognized are mentioned and are briefly described, namely an opacity, an area of increased translucency, a combination of an opacity and an area of increased translucency, and, especially, an alteration in normal radiological anatomy.

A 16-year-old girl had had a splenic abscess for approximately 20 months with minimal symptoms and signs. Progressive elevation of the left hemidiaphragm could be traced on chest radiographs from 20 months before admission, and was shown on ultrasonography, radionuclide scintigraphy and computed tomography to be secondary to massive splenomegaly. The presence of splenic abscesses was confirmed by laparotomy and she was cured by splenectomy. The nonspecific clinical presentation and potential high mortality of this condition are stressed, and the role of diagnostic aids is discussed. Ultrasonography is a good screening procedure in terms of cost and speed, but splenic scintigraphy is more sensitive. Computed tomography is the most sensitive and specific non-invasive procedure for the diagnosis of splenic abscesses.

A clinical classification embracing most of the causes of pulmonary oedema is given, as well as a radiological classification, and the different ways in which pulmonary oedema may present radiologically are briefly described.

Different approaches to the analysis of radiographs of the lungs are briefly discussed. A systematic routine is proposed, outlined and briefly motivated. It is emphasized that radiological findings must be correlated with clinical findings if meaningful conclusions are to be drawn.

The value of alveolar lavage as an investigative technique was determined in patients with interstitial lung disease. Alveolar cytology was related to defined histopathological degrees of disease activity found in transbronchial biopsy specimens. The degree of disease activity as assessed by these two techniques was compared with radiological evaluation. Adequate specimens of lung tissue for histopathological evaluation were obtained by transbronchial biopsy in 95% of the subjects during the first procedure and diagnostic histopathological changes were found in 60% of the patients. In the evaluation of disease activity, the lymphocyte-macrophage (L-M) ratio and, to a lesser extent, the total alveolar cell counts correlated well with graded histopathological changes of activity. A graded radiological evaluation of activity was accurate in 14 out of 17 patients, but in 3, extreme cellular disease ws not recognized. Alveolar cytological examination can be employed as a supplement to the biopsy technique for increased accuracy in the initial and follow-up evaluation of active interstitial lung disease. An approach combining transbronchial biopsy, alveolar lavage and radiography, provides a safe and accurate alternative to openlung biopsy in most patients for determining the aetiology and degree of activity of interstitial lung disease.