Biomedical subjects
Publications and source records attributed to M I Burrell.
A 44-year-old man with acute jejunoileitis of unknown etiology developed small bowel obstruction. Intermittent abdominal pain, bloody diarrhea, ascites, and leukocytosis were prominent features. All stool cultures were negative. On steroid treatment, symptoms and radiographic features completely resolved. We suggest, in agreement with an earlier report, that acute jejunoileitis may be regarded as a distinct clinical entity.
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Two patients with multifocal idiopathic fibrosclerosis and sclerosing cholangitis developed biliary obstruction due to a fibrotic pancreatic pseudotumor. The masslike fibrosis mimicked pancreatic carcinoma on sonography and cholangio-pancreatography. In one patient sonography was successfully used to assess the response of the pseudotumor to corticosteroid therapy.
We review the discrepancies and the reasons for them, in two articles in this issue of the Journal to conclude that clinical findings hold the key to selection of the proper imaging test in biliary obstruction. Cholescintigraphy is a more rewarding approach in detecting low grade obstruction, as by common duct stones, whereas in the patient with prolonged painless jaundice, and the high likelihood of a malignancy, computed tomography or ultrasound will yield the best results. Because of the potential for noninvasive imaging to miss choledocholithiasis and because of ever increasing therapeutic options, direct cholangiography will continue to be the mainstay in definition evaluation of the biliary tract.
We evaluated the radiologic studies of 23 patients with surgically or autopsy-documented gallbladder perforation. Extravasation was shown by cholescintigraphy and cholangiography in seven patients and corresponded to free perforation or large pericholecystic loculation. In 16 patients, ultrasonography and computed tomography detected fluid and abscesses outside the gallbladder ranging from 1 to 2 mm pericholecystic fluid collections to large phlegmonous masses. A right, upper-quadrant mass on plain films and scattered calcification in this area suggested perforation. Gallbladder perforation could be diagnosed or suspected preoperatively in ten patients and antemortem in 22 of 23 individuals. This rate of recognition, higher than previously reported, may be ascribed in part to improvements in biliary imaging.
An unusual sign of malignancy in the colon is described, consisting of an intraluminal lenticular ulcer surrounded by a meniscoid lucency of tumor. This constellation of findings was first described by Carman as a specific indicator of gastric malignancy. An aggressive ulcerating lesion with these characteristics, while rare in the colon, raises the suspicion of carcinoma.
The development of biliary strictures simulating sclerosing cholangitis is now well-known. We report a patient undergoing intraarterial chemotherapy for metastatic colon cancer of the liver in whom segmental intrahepatic biliary strictures occurred remote from known metastases. The patient remains alive 3-4 years after documented liver metastases with severe progressive portal hypertension, hypersplenism, and fat malabsorption. A table of cases so far reported is given.
The CT appearance of gastrointestinal involvement in Henoch-Schonlein syndrome is described. The protean manifestations of this disorder are easily confused both clinically and radiographically with those of many other conditions. Mural thickening, thickened folds, ulceration, and spasm are seen radiographically. The CT appearance of segmental mural thickening and luminal narrowing correlates well with the abnormalities seen on the small-bowel series and upper endoscopy.
We prospectively studied 30 patients with postcholecystectomy syndrome to determine the efficacy of biliary scintigraphy in the detection of stenosis of the sphincter of Oddi. All patients underwent endoscopic retrograde cholangiopancreatography (ERCP). Biliary scintigraphy disclosed stenosis of the sphincter by agreement with the ERCP or surgical findings in nine (90%) of ten patients and in eight (100%) of eight patients with biliary obstruction from other causes. Retention of activity at 2 hours in visually prominent ducts was the best predictor of abnormal biliary drainage. Biliary scintigraphy is a useful, noninvasive screening test for the detection of postcholecystectomy biliary obstruction.
To evaluate the role of intravenous cholangiography (IVC), ultrasound andoral cholecystography in the diagnosis of gallstone pancreatitis, 20 patients with acute pancreatitis were studied during the first three days of an attack. The IVC successfully demonstrated the common bile duct and gallbladder in 17 (85%) 20 patients. The ultrasound studies showed the gallbladder in all 18 patients in whom the gallbladder was present. The common duct was not seen by ultrasound in any patient and the pancreas was abnormal in all patients. In the three patients with gallbladder stones these were identified on both IVC and ultrasound. Common duct stones in three patients were seen only by IVC (two of these patients had concurrent gallbladder stones and one after cholecystectomy). Oral cholecystography was of limited usefulness, although the 50% visualization rate was higher than the literature suggests.
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5 cases of acute transient colitis associated with the ingestion of ampicillin, an ampicillin derivative, and penicillin are discussed. The clinical presentation, course, and radiographic and sigmoidoscopic findings are distinct from those in pseudomembranous colitis. The colonic changes may be related to an allergic reaction in the intestine which results primarily in transient ischaemia. The presenting symptom is blood diarrhoea, and barium enema is the most productive diagnostic examination.
Our regional experience in the state of Connecticut indicates that Crohn's disease is being overdiagnosed. Six patients with disorders mimicking regional enteritis are presented, one of whom had an atypical clinical course and the remainder had atypical therapeutic responses. The radiologist should be aware of clinical responses and make reassessments if necessary, in order not to overlook surgically treatable conditions.
A review of 97 patients with adult hepatorenal polycystic disease (AHRPD) revealed a significant number of patients with gastrointestinal symptoms as the initial or primary manifestation of their disease. The typical appearance of the gastrointestinal barium examinations is presented.
Metastatic breast carcinoma commonly remains silent for many years following initial diagnosis and mastectomy, and then appears as metastases at various locations. Gastrointestinal involvement is not uncommon and includes any site along the whole length of the gut, the liver, and the biliary tree; it occasionally simulates other diseases and causes difficulty in diagnosis. The radiographic features and differential diagnoses are discussed.
Eight cases of wandering spleen demonstrate that this rare entity has a characteristic constellation of findings which, though nonspecific, are highly suggestive of the diagnosis. Angiography or isotopic imaging specific for the spleen confirms the diagnosis. Asymptomatic patients may be carefully observed, with the institution of splenectomy should signs of torsion develop.
We describe the CT appearance of toxic dilatation in a patient with Crohn disease. The CT manifestations of this uncommon but important entity have not been previously described. The involved portion of the colon was mildly dilated and demonstrated pseudopolyp formation. Bowel wall thickening in this segment was minimal as expected in toxic dilatation. Intramural gas was identified representing pneumatosis intestinalis, an ominous sign in this condition.
Two cases of esophageal perforation with abdominal extension are described. Radiographic and clinical aspects are discussed with the emphasis on CT as the modality of choice for demonstrating the location and extent of extraesophageal involvement.