Biomedical subjects
Publications and source records attributed to D M Panicek.
A large perirectal mucocele developed in a child over an 11-year period following repair of an imperforate anus. Renal failure and large bowel obstruction secondary to compression by the mass were the presenting symptoms. Computed tomographic evaluation of the pelvis was critical for preoperative assessment of this previously unreported complication of imperforate anus repair.
This report documents a patient with imperforate anus in whom an endorectal pull-through with incomplete excision of the macroscopic mucosa led to the formation of a 1,500 mL mucosal lined pelvic mucocele, obstructing both the rectum and ureter. All macroscopic mucosa should be removed during endorectal pull-through.
Chest tube tracks may simulate normal structures or pathology. This article will help the radiologist to understand their formation and to recognize them as iatrogenic shadows.
The classic features of six common pulmonary developmental anomalies have been presented. In addition, several overlap cases, each demonstrating features of more than one anomaly, have been illustrated. Such cases serve to emphasize that pulmonary developmental anomalies exist as a continuum, often frustrating our attempts at discrete classification. Future advances in pulmonary embryology may further elucidate the pathogenesis of these entities.
The chest radiograph of a 79-year-old man with acute thoracic aortic rupture demonstrated enlarged, ill-defined bronchovascular markings. Examination of the lungs at autopsy revealed extensive dissection of blood from the mediastinum along the bronchovascular sheaths. Recognition that enlarged bronchovascular markings may represent hemorrhage rather than edema in the setting of acute aortic rupture has important therapeutic implications.
Bilateral peripheral pulmonary infiltrates caused by Pneumocystis carinii developed in a patient undergoing mediastinal irradiation after chemotherapy for Hodgkin disease. The paramediastinal part of the lung included within the treatment port remained clear during the 2 1/2 weeks of radiation therapy. The distribution of the pneumocystis infiltrates was altered by the radiation, producing a pattern that is the "radiographic negative" of typical post-radiation therapy paramediastinal fibrosis.
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Hepatic parenchymal gas was demonstrated by computed tomography in a boy who had sustained severe blunt trauma to the abdomen 12 hours earlier. There was no clinical evidence of infection. Although previous reports have suggested that hepatic parenchymal gas indicates the presence of infection, such gas may also be a manifestation of severe blunt trauma without infection.
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Bacillus Calmette-Guerin was administered through the ileal conduit of a 63-year-old man with upper tract recurrence of transitional cell carcinoma. Subsequent computed tomography showed bilateral renal masses, which were granulomatous at pathologic examination. The bacilli likely reached the kidneys via proven ileoureteral reflux. Patients with reflux may benefit from antituberculous prophylaxis.
Cystoendoscopic examination and standard radiological techniques occasionally fail to correctly establish that a pelvic mass is due to carcinoma arising within a urinary bladder diverticulum. MR imaging in oblique planes can facilitate the diagnosis in such cases by demonstrating the neck of the diverticulum. Also, T2-weighted images allow differentiation between tumor within a diverticulum and a necrotic extravesical mass.
We report a case in which computed tomography (CT) demonstrated gas within a thrombus in the superior vena cava in a patient with fever of unknown origin (FUO), indicating that the thrombus was infected. This CT finding is important to recognize, as it affects subsequent therapy.
Computed tomography in four cases of urine extravasation due to ureteropelvic disruption secondary to blunt trauma were compared with CT in 15 cases of renal parenchymal injury. In three cases of isolated ureteropelvic disruption the renal parenchyma was intact; contrast medium excretion was normal; no perirenal hematoma was present. Contrast medium extravasation was confined predominantly to the medial perirenal space. The ipsilateral ureter was not opacified in three of the four cases of ureteropelvic disruption. These CT findings of ureteral injury are distinct from those of renal parenchymal injury. When these findings are present on CT done for trauma, confident diagnosis of ureteral disruption can be made. In one case, combined renal parenchymal injury and ureteropelvic disruption occurred.
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PURPOSE: This prospective study was undertaken to determine the incremental yield of combined abdominal and pelvic CT in searching for clinically suspected postoperative abscess in oncologic patients. METHOD: One hundred seventeen oncologic patients underwent CT to exclude a clinically suspected abscess within 30 days of abdominal or pelvic surgery during an 8 month period. Scans were evaluated for the presence of ascites, loculated fluid collections, or other possible sources of fever. The clinical course and any intervention in the abdomen or pelvis within 30 days after CT were recorded. RESULTS: After abdominal surgery, 44 of 69 [64%; confidence interval (CI) 51-75%] patients had loculated fluid collections in the abdomen; no patient (0%; CI 0-5%) had a loculated fluid collection present only in the pelvis. After pelvic surgery, 22 of 48 (46%; CI 31-61%) patients had loculated fluid collections in the pelvis; no patient (0%; CI 0-7%) had a loculated collection present only in the abdomen. Loculated collections were present in both the abdomen and the pelvis in 4 of 69 (6%; CI 1.6-14%) patients after abdominal surgery and 3 of 48 (6%; CI 1.3-17%) after pelvic surgery. CONCLUSION: Isolated pelvic abscesses after abdominal surgery and isolated abdominal abscesses after pelvic surgery appear to be very uncommon in oncologic patients. CT initially need be directed only to the region of surgery in this particular patient population.
PURPOSE: Our goal was to determine whether spleen or muscle can be used as a qualitative standard of reference for diagnosing fatty infiltration of liver on contrast-enhanced CT. METHOD: Qualitative visual comparisons and quantitative region-of-interest measurements of liver, spleen, and muscle were made on scans of 96 patients who underwent dynamic CT before and after injection of intravenous contrast material. As the standard of reference, the portion of liver assessed was considered fatty if its attenuation measured less than spleen on noncontrast CT. RESULTS: In 16 (17%) scans, the portion of liver assessed was fatty on noncontrast CT. After contrast material administration, the attenuation of that portion of liver measured less than splenic attenuation in 93 (97%) of 96 cases (including all 16 fatty livers). Only four (25%) fatty livers, and no nonfatty livers, were visually judged to be less attenuating than muscle after contrast material; these four were the most fatty shown on noncontrast CT. Comparing hepatic and splenic attenuation on postcontrast CT resulted in a specificity of 30% and a positive predictive value of 20%; comparing hepatic and muscle attenuation on postcontrast CT yielded corresponding values of 100 and 100% but a sensitivity of 25%. CONCLUSION: For the visual assessment of fatty liver, spleen is not an accurate reference standard on contrast-enhanced CT. However, fatty liver can be diagnosed on contrast-enhanced CT if liver appears less attenuating than muscle-a situation that occurs only if fatty infiltration is pronounced.
Two cases of non-Hodgkin lymphoma (NHL), one AIDS related, with hepatic involvement manifesting as infiltrating mass-like periportal intrahepatic low attenuation on CT are described. One case demonstrated mass effect with compression of adjacent bile ducts causing jaundice. NHL should be included in the differential diagnosis of mass-like periportal intrahepatic low attenuation lesions.