PROGRESS in diagnostic roentgenology need not always be along such lines as new expensive equipment, complicated injections, or even new opaque materials. It may result from a simple correlative reevaluation of existing roentgen criteria, as illustrated in the subject of this paper.
For example, in our hands a sharp, clear-cut differential diagnosis between unilateral upper lobe chronic inflammatory disease (usually tuberculosis) and cancer (usually bronchogenic carcinoma) had ofttimes been a serious problem. This embarrassing difficulty led us directly to an analytical roentgen study in the hope that one or more of the existing criteria could be utilized as a stable differential factor.
Critical analysis soon provided us with such a differential sign. It was consistently noted that unilateral upper lobe cancer was not associated with homolateral tracheal buckling, while inflammatory disease (usually tuberculosis) was. This difference was so striking that we began to use it routinely as a differential feature
POPPEL MH, JACOBSON HG, DEWING SB. TRACHEAL BUCKLING: Differential Roentgen Sign. AMA Arch Otolaryngol. 1953;57(1):44–50. doi:10.1001/archotol.1953.00710030061005
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