The correlation of subcarinal density visualized on plain chest roentgenograms with computed tomographic scans

A prospective evaluation of 212 paired chest roentgenograms and computed tomographic (CT) scans was performed to determine the predictive value of detecting subcarinal adenopathy by finding increased subcarinal density on routine roentgenograms. Based on CT criteria for subcarinal lymphadenopathy, 37 true-positive and 124 true-negative cases of subcarinal adenopathy were found in 161 patients. Evaluation of density in the subcarinal area on the routine posteroanterior (PA) chest roentgenograms in these patients demonstrated a sensitivity of 72 percent and specificity of 96 percent for the detection of adenopathy when compared with established CT criteria. False-positive and false-negative appraisals of central mediastinal density on routine roentgenograms appear to be due to the super-imposition of other masses, bullae, or lack of appropriate roentgenographic contrast. The accuracy of predicting the presence or absence of subcarinal adenopathy from routine chest roentgenograms suggests that this observation is clinically useful and should be routinely evaluated.