Radiology

Brasch, R C; Gooding, C A; Lallemand, D P; Wesbey, G E

doi: N/Apmid: 6691102

Magnetic resonance (MR) imaging was performed in 10 children with intrathoracic disease. Entities imaged included mediastinal lymphoma and neuroblastoma, pulmonary metastases from hepatoblastoma and osteogenic sarcoma, hemorrhagic pleural effusion, and nonmalignant disease such as abscess, cystic fibrosis, and bronchogenic cyst. MR imaging was particularly valuable in delineating mediastinal and parenchymal masses from adjacent vascular structures without the need for contrast material enhancement. However, MR was insensitive to lesion calcification. Since pulmonary vessels give very low signal, differentiation of high-intensity pulmonary nodules from vessels is readily apparent. For similar reasons, MR was excellent in distinguishing endobronchial mucus plugs from peripheral pulmonary vessels.

Schwarten, D E

doi: N/Apmid: 6228953

A group of 25 patients who had suspected aortoiliac disease was screened using digital subtraction angiography (DSA) and conventional catheter arteriography with an overall accuracy of 88% for DSA. A second group of 50 consecutive patients who had undergone iliac angioplasty at least two years previously was examined with DSA, and a satisfactory examination was obtained in 94% of the cases; 89% of the angioplasty sites remained free of significant stenotic disease without evidence of complications related to angioplasty. We compared findings of DSA of the aortoiliac segment with findings of Doppler examinations and found the procedures to be complementary. We conclude that DSA is a reliable method for follow-up of iliac angioplasty sites, and meets with considerable acceptance from patients.

Cloogman, H M; DiCapo, R D

doi: N/Apmid: 6691112

Three cases of hereditary hemorrhagic telangiectasia were evaluated by ultrasound. The sonographic findings included demonstration of an abnormally dilated common hepatic artery, multiple arteriovenous malformations, and abnormal echogenicity of the liver.

Levine, M S; Caroline, D; Thompson, J J; Kressel, H Y; Laufer, I; Herlinger, H

doi: N/Apmid: 6691080

Primary adenocarcinoma of the esophagus is thought to be a rare lesion. However, pathologic records at our institution from 1979 to 1982 show that adenocarcinoma accounted for 17 of 89 (19%) of all primary malignant tumors in the esophagus. All 17 cases arose in Barrett mucosa. In eight cases, there was surgically proved involvement of the gastric cardia or fundus. In six of these cases, there was evidence of esophageal dysplasia and/or carcinoma in situ adjacent to or remote from the proximal margin of the tumor. The pathologic findings therefore strongly suggest an esophageal origin of these lesions with subsequent spread into the stomach. Clinical and radiographic findings at presentation were indistinguishable from those of squamous cell carcinoma. However, 10 patients had long-standing reflux symptoms, and Barrett esophagus had presumably been present for some time prior to the development of malignancy. Since adenocarcinoma evolves through a sequence of dysplasia and carcinoma in situ in pre-existing Barrett epithelium, the best hope for improving survival may be periodic endoscopic surveillance of asymptomatic individuals who have this condition.

Mitnick, J S; Pinto, R S; Lin, J P; Rose, H; Lieberman, A

doi: N/Apmid: 6691090

Thrombosed arteriovenous malformations (AVMs) in children are rare lesions that may present with headaches or a seizure disorder. Thirteen patients (4 months to 21 years of age) with this lesion were examined with computed tomography (CT). In 11 patients surgical confirmation was obtained, and the other two patients were examined with follow-up CT scans. Angiography either showed an avascular mass (7/13) or was negative (6/13). CT showed a lobulated lesion (8/13), peripheral location (11/13), and minimal surrounding edema (8/13). All of the lesions were hyperdense prior to the administration of contrast material and all enhanced either slightly or not at all following contrast material administration. It is concluded that these characteristic CT features aid in making the diagnosis of thrombosed AVM. The major differential diagnosis is small intracerebral neoplasm.

Vincent, L M; Mauro, M A; Mittelstaedt, C A

doi: N/Apmid: 6691111

The sonographic appearance and differentiation of fluid collections within the gastrohepatic recess and lesser sac are described. The identification of the lesser omentum and stomach is fundamental to their separation. Accurate localization of upper abdominal fluid may be of aid in selecting an appropriate approach for paracentesis as well as directing the subsequent diagnostic work-up.

Schreiman, J S; Gisvold, J J; Greenleaf, J F; Bahn, R C

doi: N/Apmid: 6691113

A preliminary clinical study of ultrasound transmission computed tomography of the breast (UTCTB) was undertaken to evaluate its capacity in the detection of breast abnormalities and to establish criteria for distinguishing benign from malignant lesions. Only patients with palpable and/or mammographically evident lesions were selected for study; complete analysis was accomplished in 78 cases. Visual and computer interpretations of reconstructed UTCTB scans were based on changes in speed of sound wave transmission and attenuation between the suspicious area and the surrounding tissue. In the computer-aided classification, discriminant functions were derived to predict the presence or absence of carcinoma. Visual analysis was subject to a low sensitivity. The presence of high speed transmission within a lesion usually indicated malignancy, although the converse was not true. Computer-aided preliminary screening of UTCTB scans by a trained technician may have the potential of contributing to interpretation accuracy; however, this finding must be highly qualified, given the methodologic constraints of the study.

Byrne, P; Leung, J W; Cotton, P B

doi: N/Apmid: 6691089

Perforation into the retroperitoneal space may occur during duodenoscopic sphincterotomy and can be recognized radiographically. While it is potentially serious, most patients should respond to conservative management provided that adequate biliary drainage is achieved. Five cases encountered during approximately 500 sphincterotomies are presented. Radiographs taken 24 hours after 50 additional procedures showed no evidence of perforation.

Risius, B; Zelch, M G; Graor, R A; Geisinger, M A; Smith, J A; Piraino, D W

doi: N/Apmid: 6691087

Fifty-six patients with acute or chronic arterial or venous thromboembolic occlusions received treatment with low dose (5,000 U per hour) streptokinase via an indwelling intravascular catheter. Successful clot lysis was achieved in 13 of 14 (92%) postprocedural occlusions that were less than one week in age, in 8 of 11 (73%) atherosclerotic occlusions that were less than six weeks in age, in 2 of 3 (67%) emboli from cardiac thrombi, and in all of the pulmonary emboli and superior vena cava occlusions. In the chronic occlusions, successful thrombus lysis occurred less frequently (8 of 21, 38%). Although the initial objective of fibrinolytic therapy is clot lysis, the long term clinical success depends on the diagnosis and treatment of the underlying cause of the thromboembolism.

Schwarten, D E

doi: N/Apmid: 6228954

A group of 50 consecutive patients who had undergone successful renal angioplasty two or more years previously was studied by video digital subtraction angiography (DSA). Thirty additional patients were studied by both DSA and conventional catheter arteriography. Among the 30 patients, DSA findings agreed with the arteriographic findings in 87% of the examinations: 92% of the postangioplasty patients had satisfactory DSA examinations. Using DSA two years after angioplasty, we were able to determine a restenosis rate of 22.5% among patients with atherosclerosis and of 0% among patients who had fibromuscular disease. DSA provides a useful method to follow-up renal angioplasty, and it is well accepted by patients.