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Though transthoracic needle biopsy (TNAB) is a well established method for obtaining pathologic diagnosis in lung masses, very often the procedure is only performed after a previous negative bronchoscopic biopsy (BB) attempt. In this study we analyzed the results of TNAB in 129 consecutive patients where one or more inconclusive BB had been performed. TNAB was diagnostic in 115 of 129 lesions (89%) and the yield was not significantly affected by size, cell type or tumour location. In 97 patients who underwent thoracotomy, cytologic specimens obtained by TNAB accurately reflected histologic tumour type in all cases. A false negative rate for malignancy on TNAB was 5%. Awaiting inconclusive BB results caused an average delay of three in-hospital days before TNAB. In those patients in whom a biopsy is warranted, TNAB is most useful as an initial diagnostic procedure in masses that are peripheral and in pleural based tumours, in mediastinal adenopathy associated with a lung mass and instead of a repeat, previously failed bronchoscopy.

Repeat sternotomy for cardiac recuperation has the risk of life-threatening hemorrhage, the result of accidentally sectioning the cardiovascular structures behind the sternum. The mortality rate of this complication is about 37%1 Patients with ascending aortic aneurysm or right ventricle to pulmonary artery conduits are at higher risk for this complication.2 Preoperative assessment of proximity of vascular structures to the sternum can substantially decrease the mortality rate from hemorrhage by alerting the surgeon to prepare for this complication. Frontal and lateral chest radiographs and angiography are not helpful in predicting this event. Thoracic computed tomography (CT) provides excellent anatomic evaluation of the sternum and its surrounding structures.3 We describe the role of CT in predicting intraoperative injury to cardiovascular structures during repeat sternotorny.

Tetralogy of Fallot associated with atrioventricular (AV) canal is a well-recognized cardiac malformation; its surgical repair carries a high mortality, which is related partly to the complexity of the defect and partly to incomplete diagnosis. Hence an accurate preoperative diagnosis is essential. This communication describes the angiographic features observed in 17 patients with tetralogy of Fallot and AV canal with emphasis on the morphology of the right AV valve as seen during the right ventriculogram. A complete anatomic diagnosis can be consistently made from right and left ventriculograms performed in axial projections.

Pulmonary vascularity in patients with pulmonary atresia and ventricular septal defect varies widely and depends on the anatomic and functional status of the main pulmonary artery and the left and right pulmonary arteries in their central, hilar and intrapulmonary segments. In pulmonary atresia and ventricular septal defect, there are three main patterns of pulmonary vascularity seen on the plain chest radiograph: 1, diminished pulmonary vascularity; 2, plethora with increased pulmonary blood flow often associated with horizontal arteries suggesting aortopulmonary collaterals; and 3, asymmetric vascularity indicating stenosis within the pulmonary arterial tree. A mottled appearance at the periphery of the lungs represents pleural-pulmonary collateral circulation. The anatomic and functional status of the pulmonary circulation can be demonstrated by opacification of the channels that supply the pulmonary arterial system either by selective or nonselective methods or through pulmonary venous wedge retrograd...

Heterotopic heart transplantation can be performed in the presence of high pulmonary vascular resistance. The authors call attention to a rare, but potentially life-saving procedure.

An analysis of 6 patients with overriding atrioventricular valve was performed in order to correlate the anatomic and angiographic features of this malformation. The atrial arrangement was usual (situs solitus) in each patient. The ventricular chambers were normally related in 4 and the mirror image of normal in 2. The atrioventricular connexion was concordant in parallel fashion in 4, discordant in 1 and double inlet left ventricle in 1 heart. In 2 of 4 hearts with concordant atrioventricular connexion, the right atrioventricular valve (tricuspid) overrode the septum and connected partially to the left ventricle. In 2, the left atrioventricular valve (mitral) overrode the septum and partially connected with the right ventricle. One heart with discordant atrioventricular connexion had its right atrioventricular valve (mitral) overriding the septum. The remaining heart with double inlet left ventricle had an overriding left atrioventricular valve. Each overriding atrioventricular valve had its "septal" leaflet (the one committed to the contralateral ventricle) divided into 2 segments by a large cleft. Ventricular septal defects at different locations were present in all cases. The ventriculoarterial connexion was double outlet right ventricle in 5 patients and was discordant in 1. Malalignment of the atrial and ventricular septa was present to some degree in all cases. This was well depicted on ventriculograms in four chamber view in those with an overriding tricuspid valve. It was not detected in those with an overriding mitral valve. The displaced leaflets of the overriding and/or stradding valve had a vertical motion on cineangiograms similar to those observed in atrioventricular septal defects. Abnormal morphology and motion of the septal leaflet of the overriding atrioventricular valve and malalignment of the atrial and ventricular septal structures were the most important angiographic findings in this series.

A segmental angiographic analysis of congenital heart malformations has been developed with the intention of making evaluation of complex congenital heart anomalies as comprehensive as possible. Each vascular and cardiac segment is analysed sequentially, considering morphology, connections, and relations. Additional associated cardiovascular abnormalities such as shunts, stenoses, hypoplasias and atresias are also considered. Information analysed and presented in this way has more immediate anatomic and physiologic meaning than ambiguous terms, often with obscure embryologic implications. Disagreements regarding definitions and nomenclature will continue; however, a logical framework that allows clear communication among cardiologists, surgeons, and angiographers is absolutely necessary and is provided by the orderly analysis presented here.

Acute and subacute infection in the mediastinum, though rare, is associated with a substantial mortality which increases with delay in diagnosis. The conventional radiographic and computed tomographic studies of 14 patients with proven infective mediastinitis were reviewed in an attempt to identify their relative roles in its diagnosis. Signs of infection demonstrated by computed tomography (CT) included abscess formation, mediastinal masses, soft tissue collections contiguous with other infected compartments and areas of diffuse mediastinal infiltration with fat plane loss without prominent lymphadenopathy. The anatomy and extent of the infection was well delineated by CT in all patients. In nine cases this information affected clinical management, facilitating percutaneous drainage of the abscess in three. In five patients, information from CT did not alter clinical management.

A one-day-old full-term female infant with massive "cardiomegaly" developed marked respiratory distress soon after birth. The two-dimensional (2D) echocardiogram demonstrated a 4 X 5-cm cystic mass adjacent to the left ventricular free wall. Computed tomography (CT) confirmed the presence and dimension of the cyst and CT number indicated the fluid within the cyst to be serous. A pericardial cyst was successfully removed at thoracotomy. Two-dimensional echocardiography and CT, both noninvasive procedures, are fully adequate tools in the diagnosis of pericardial cysts in the neonate, so that invasive investigations may be avoided.