Biomedical subjects
Publications and source records attributed to B Raval.
Clinically unsuspected pseudoaneurysm formation of the arterial anastomosis in a patient with a renal transplant was initially diagnosed by computed tomography. This rare but serious complication can also be detected by ultrasound or radionuclide flow study, as shown in our patient. An awareness of this lesion and familiarity with its appearance can permit its early detection before exsanguinating hemorrhage occurs.
A method is described for obtaining consistently high-quality images during nonneurologic computed tomography of the severely ill and uncooperative patient using a neuromuscular blocker to induce apnea. Careful control of respiration during data acquisition eliminates motion artifacts.
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The development and refinement of computed tomography have revolutionized the diagnostic evaluation of patients in urologic practice. This article reviews the applications and interpretation, as well as the limitations, of renal computed tomography and compares this modality with other imaging studies of the kidney.
Reported here is a patient with celiac disease in whom a spurious pelvic mass was suggested by computed tomography. This pitfall can be prevented by an awareness of the normal appearance of the small bowel following intravenous contrast enhancement and by monitoring of the examination by a radiologist. Delayed scanning or real-time ultrasound examination will confirm that the initial computed tomography appearance is due to small bowel loops.
Untreated mediastinal Hodgkin's lymphoma may present with calcification within the tumor mass. Therefore, Hodgkin's lymphoma should be included among the possible diagnoses of calcification in an anterior mediastinal mass, as visible on chest CT or mediastinal tomography.
Five cases in which computed tomography (CT) detected a hypernephroma that had been missed by one or more of the other imaging modalities are reported here. Computed tomography may have an important role in the diagnosis of radiologically occult hypernephroma.
A patient with carcinoma of head of pancreas is described. The density of liver metastases on computed tomography was much higher than the density of the surrounding liver parenchyma due to the fatty infiltration of liver.
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Data for 94 patients clinically suspected of having extrahepatic biliary obstruction who were referred for radiologic investigations were studied to compare the value of various imaging modalities used to detect this condition. Computed tomography emerged as the best indirect, noninvasive technique and percutaneous transhepatic cholangiography as the best direct technique. A standard approach to investigating suspected extrahepatic biliary obstruction is suggested that takes into consideration the interventional radiologic techniques currently used to treat this condition.
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CT findings in 32 patients with abdominal and pelvic trauma are the subject of this report. Four patients had more than one organ involved. The most common abdominal organ to be injured in our series was the pancreas, unlike other series. Findings of pancreatic, splenic, hepatic, renal, and pelvic injuries are described. The role of CT in the investigation of a patient with abdominal and pelvic trauma is discussed and compared with other imaging modalities. CT was found to be superior especially as it is highly sensitive and not organ specific.
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Endoscopic papillotomy is a major therapeutic advance in the management of common bile duct obstruction. During 1981, the procedure was performed in 48 of 51 patients between 17 and 93 years of age. There were 13 men and 35 women. Common duct stones were removed in 26 of 31 patients (84%), six of whom had their gallbladders in place and two of whom had cholangitis. Failure in five patients occurred because of stone adherence to the common duct wall, stone size, ductal stenosis, or caught Dormia basket. Papillotomy was done in 10 of 11 patients for stenosis, two for recurrent pancreatitis, two with the sump syndrome, one for hemobilia, and one for bile duct tumor biopsy. The "precut" technique was required in 11 patients. Mild pancreatitis developed in three patients and severe hemorrhagic pancreatitis in one. Three of the four had the precut technique. One patient had minor bleeding, and two developed acute cholangitis requiring laparotomy, one of whom died (2.1%) 40 days after initial endoscopic papillotomy. A Dormia basket became caught in one patient. The duration of hospitalization was 24 to 36 hours after endoscopic papillotomy. Endoscopic papillotomy is considered the method of choice in the management of postcholecystectomy choledocholithiasis.
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A review of 15 months' experience shows the major indications for sagittal and coronal reconstruction images in computed body tomography (CBT) are in the differentiation of lung disease from disease of the chest wall; of supradiaphragmatic from infradiaphragmatic lesions; of intrahepatic from perihepatic abnormality; of renal from perirenal disease; in establishing the level of obstruction in the jaundiced patient and in mapping pelvic malignancy. The accurate definition of the extent of disease proved beneficial in planning further diagnostic procedures (needle aspiration for malignant cells or abscess drainage), in determining the surgical approach, and in planning radiation therapy.