Progressive stridor and hoarseness in a young black woman.
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Adult↗
Biomedical subjects
D Picus
Publications and source records attributed to D Picus.
Small-bowel disease: categorization by CT examination.
Fifty patients with no small-bowel disease were evaluated by CT to determine the normal appearance of the small bowel and mesentery. Subsequently, the CT findings in 95 patients with proven small-bowel disease were analyzed to determine which CT observations correlated with neoplastic, inflammatory, or edema-producing processes. Thirty-three (83%) of 40 patients with wall thickening or mesenteric masses greater than 1.5 cm had a neoplastic process. Twenty-eight (82%) of 34 patients with normal mesenteric fat attenuation, wall thickening less than 1.5 cm, or mesenteric masses less than 1.5 cm had inflammatory disease. Fourteen (67%) of 21 patients with no mesenteric mass, increased mesenteric fat attenuation, and wall thickening less than 1.5 cm had noninflammatory edema. Overall, CT assigned 75 (79%) of 95 patients into appropriate categories; use of ancillary CT findings led to correct categorization in 83 (87%). CT is helpful in correctly assigning a disease category to patients with small-bowel wall thickening.
Diagnosis, Differential↗
Magnetic resonance imaging of the female pelvis.
Magnetic resonance (MR) imaging is particularly well suited for the evaluation of the female pelvis because of the lack of respiratory motion and the multiplanar imaging ability of MR. The MR appearance of normal anatomy is dependent on the pulse sequence used. This is also true for pelvic pathology. Primary cervical carcinoma is best seen on T2-weighted images; parametrial extension and lymph node metastases are best evaluated on T1-weighted images. Endometrial carcinoma is also best seen on T2-weighted images. Absence of the junctional low intensity band of the uterus may indicate myometrial invasion by endometrial tumor, although more data are needed to make a final diagnosis. Uterine leiomyomata have a variable MR appearance which may be related to the degree of cellularity of the tumor. Our experience in the MR appearance of adnexal masses is limited. MR imaging should assume a more important role in imaging the female pelvis in the future.
Cervix Uteri↗
Right upper quadrant pain and tenderness in a young man.
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Bile Duct Diseases↗
Intercostal-space nephrostomy for percutaneous stone removal.
Intercostal-space nephrostomies were created in 50 kidneys for removal of 17 staghorn, 9 calyceal, and 24 ureteral calculi. Complications were encountered in six [12%] of 50 patients. These included large pleural effusions in four patients and hydropneumothoraces in two patients. Four patients (8%) had chest tubes placed. The intercostal approach provides direct, straight access to both upper-pole and ureteral calculi as well as to the major portion of most staghorn calculi. Although the morbidity rate is slightly higher than for the more traditional approach via the subcostal lower pole or middle calyx complications generally can be avoided by using a working sheath and placing a large nephrostomy tube after the procedure.
Adult↗
The uterus: in vitro MR-anatomic correlation of normal and abnormal specimens.
Magnetic resonance (MR) images of 12 fresh uterine specimens obtained with a high-resolution surface coil were correlated with findings on gross and microscopic pathologic examination. The uterine wall can be differentiated into three distinct zones: a central high-intensity zone, a junctional low-intensity band, and a peripheral medium-intensity area. Whereas the endometrium (basale and functionale) corresponded to the high-intensity zone, the myometrium correlated best with the combined width of the areas of low and medium signal intensity. The signal intensity of a leiomyoma varied, depending on its cellularity. Primary endometrial and cervical carcinomas were clearly shown on MR images, as were other abnormalities such as adenomyosis and Nabothian cysts. The potential usefulness of MR imaging in detecting and staging uterine neoplasms is discussed.
Adult↗
Intraarterial digital subtraction angiography of renal transplants.
Twenty-four intraarterial digital subtraction angiography (IA-DSA) studies were performed in 23 renal transplant recipients for evaluation of possible postoperative complications. Ten patients had normal studies. Five patients had minimal (less than 50%) narrowing at the renal artery anastomosis and five had more severe stenoses. Three patients had vascular occlusions. IA-DSA results correlated well with findings at surgery and/or conventional angiography. The major advantage of IA-DSA is the small amount of contrast material needed to perform the study. IA-DSA is particularly well suited to the evaluation of vascular problems in renal transplant patients.
Adolescent↗
"Discphagia": a case report.
An anterior herniated intervertebral disc at the low cervical level caused dysphagia and an extrinsic impression on the esophagus seen on barium swallow. This entity should be added to the differential diagnosis of extrinsic esophageal defects.
Deglutition Disorders↗
Abdominal computed tomography in children with unexplained prolonged fever.
Twenty-eight children with unexplained fever lasting at least 1 week were referred for CT of the abdomen. Of the 28 patients, 22 had clinical and radiographic findings localizing disease to the abdomen prior to CT. In these 22 patients CT correctly detected an abnormality in 19 of 22 (86%) and favorably affected therapy in 13 of 22 (59%). In the six patients without localizing findings CT was abnormal in two and normal in four. Computed tomography was correct in all six patients and favorably affected management in two patients. Our results suggest that in children with fever and findings localizing disease to the abdomen--especially the retroperitoneum--CT is helpful in diagnosing a wide variety of lesions, as well as influencing therapy. If no localizing signs are present, CT has a relatively lower yield.
Abdomen↗
Gastrohepatic ligament: normal and pathologic CT anatomy.
In a review of 200 consecutive CT scans of the upper abdomen, the structures within the gastrohepatic ligament (GHL) were well seen in 182 (91%). In 85% of these 182 patients, the largest structure visible within the GHL was 6 mm or smaller. A total of 27 patients had a structure larger than 6 mm within the GHL; this finding could be explained in 13 by the presence of a normal anatomic variant. Of the 14 others, 12 had known tumor arising in or known to have spread to the upper abdomen. Two patients had no obvious explanation. Fourteen patients with cancers of the stomach (9 patients), pancreas (3 patients), and esophagus (2 patients) had 57 intact nodes that were evaluated pathologically. Of these 40/40 benign nodes and 10/17 malignant nodes were less than or equal to 8 mm in size. When anatomic variants are excluded, the finding of rounded structures greater than 8 mm in the GHL is a reliable indicator of left gastric node involvement by carcinoma or lymphoma or of coronary venous dilatation.
Humans↗
Radical pancreatectomy: postoperative evaluation by CT.
Twenty-four patients who had undergone radical pancreatic resection were evaluated by CT one week to 11 years after surgery. Eighteen patients had had the Whipple procedure; six had had total pancreatectomy. The region between the aorta and superior mesenteric artery, previously occupied by the uncinate process of the pancreas, is an important area to evaluate for tumor recurrence because periampullary tumors tend to metastasize to the lymph nodes in this region. Tumor recurrence here is readily detectable by CT since radical pancreatectomy leaves this area free of soft tissue attenuation material. Administration of glucagon prior to CT scanning helps fill the afferent jejunal loop with oral contrast material, and thus helps define right upper quadrant anatomy. CT demonstrated postoperative complications or tumor recurrence in 16 of the 24 patients and was 100% accurate in patients who had follow-up.
Adult↗
Iatrogenic femoral arteriovenous fistulae: evaluation by digital vascular imaging.
Intravenous digital vascular imaging was used to evaluate eight patients with suspected iatrogenic femoral arteriovenous fistulae. These followed either cardiac catheterization (seven) or pulmonary angiography (one). All cardiac catheterization patients had undergone simultaneous ipsilateral femoral artery and vein puncture, possibly contributing to the high incidence of arteriovenous fistulae in this group. Digital imaging studies in two patients were normal, confirmed by clinical follow-up without surgery. In six patients, digital vascular imaging correctly predicted the presence and relative size of the fistulae, as confirmed at surgery. Although the exact site could not be specified, it was correctly identified to within 4 cm. None of these patients required arteriography for further study of the lesion before surgical repair.
Adult↗
Computed tomography of abdominal carcinoid tumors.
Computed tomographic (CT) scans were obtained in 20 patients with primary and/or metastatic abdominal carcinoid tumors. The primary tumors were seen rarely on CT. Mesenteric involvement was seen in eight of the 20 patients, usually as a soft-tissue mass surrounded by fat and radiating soft-tissue strands. Enlarged retroperitoneal lymph nodes were seen in seven patients, but rarely were they the only manifestation of intraabdominal disease. The most common finding was liver metastases (13 of 20 patients). CT is helpful in evaluating the extent of tumor before surgical exploration and in following the progression of disease once the diagnosis has been established.
Adult↗
Plain radiography with a rare-earth screen: comparison with calcium tungstate screen.
Plain radiographic examinations were performed on 388 patients (adult and pediatric) using either a calcium tungstate or rare-earth screen. Radiographs were compared for overall image quality, mottle, contrast, density, and detail. The rare-earth screen produced radiographs with significantly more mottle than did the standard screen. However, this was almost never of diagnostic importance. A small but significant decrease in overall image quality also was found with the rare-earth screen. This was the result of minor differences between the grading of optimal and good. A major advantage of rare-earth screens is a 50% or more reduction in radiation exposure. The results here show that rare-earth screens may be used in plain radiographic examinations without a clinically important decrease in image quality.
Adult↗
Computed tomography in the staging of esophageal carcinoma.
The computed tomographic (CT) findings in 52 patients with histologically proved esophageal carcinoma were reviewed. In 30 of these patients, the CT findings were correlated with findings at surgery or autopsy. CT was found to be highly accurate in predicting tumor size and assessing invasion of the tracheobronchial tree and spread to the liver, adrenals, and celiac and left gastric nodes. By quantifying the contact between the tumor and aorta, it was found that the CT appearance correctly predicted the presence or absence of aortic invasion in 24 of 25 cases (five cases were indeterminate). CT was insensitive in detecting metastatic spread to local periesophageal nodes; in these cases the tumor tended to involve the nodes without enlarging them. CT is an accurate method for assessing the spread of esophageal carcinoma. Its use can prevent unnecessary surgery in patients with inoperable tumors.
Adenocarcinoma↗
Perforated appendix presenting with severe diarrhea. Findings on barium-enema examination.
Severe diarrhea and marked lower abdominal cramps are unusual manifestations of appendicitis. The authors performed a barium-enema examination (BE) on 9 pediatric patients who were ultimately shown to have a perforated appendix and pelvic abscesses. In 8 cases, the atypical symptoms initially led to an incorrect clinical diagnosis. In all 9, the BE demonstrated extensive inflammatory changes of the rectosigmoid colon, caused by the surrounding pelvic infection. Recognizing this clinical and radiographic association could lead to earlier diagnosis and treatment.
Appendicitis↗
Tc-99m sulfur colloid scintigraphy for detecting perigraft flow following endovascular aortic aneurysm repair: A feasibility study.
PURPOSE: To determine if scintigraphy with Tc-99m sulfur colloid can be used to detect perigraft flow after stent-graft repair of abdominal aortic aneurysm (AAA). METHODS: Twenty-three men and two women aged 56-84 years (mean 71 years) underwent endoluminal AAA repair as part of the EVT Phase II trial [EVT = Endovascular Technologies (Menlo Park, CA, USA)]. Aneurysm size averaged 5.4 cm (range 3-8 cm). Sixteen bifurcated, seven tube, and two aorto-uniiliac grafts were placed. Two days after stent-graft placement, patients underwent both contrast-enhanced computed tomography (CT), including delayed views, and Tc-99m sulfur colloid scintigraphy. RESULTS: Perigraft flow was found in only one patient at completion of angiography. Four additional patients had perigraft flow, discovered during their postoperative follow-up CT. Four patients had leaks at an attachment site and one had retrograde branch flow. Tc-99m sulfur colloid scintigraphy failed to diagnose any of the five leaks prospectively. In two of these patients, however, some abnormal paraaortic activity was noted in retrospect. CONCLUSION: Tc-99m sulfur colloid scintigraphy was unable to demonstrate endoleak with either rapid flow (attachment site leak) or slow filling (branch flow).
Aged↗