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Biomedical subjects

M Oliphant

Publications and source records attributed to M Oliphant.

At least 37 records · Page 2Linked to original sources

Imaging the direct bidirectional spread of disease between the abdomen and the female pelvis via the subperitoneal space.

This report expands the concept of the subperitoneal space (SS) as the potential conduit for direct spread of disease in the abdomen to include the female pelvis. The normal anatomy of the SS in the lower abdomen, the female pelvis, and its uninterrupted continuation between the abdomen and pelvis are demonstrated by several imaging modalities. Surgically proven cases of bidirectional spread of disease between the abdomen and female pelvis are reported. The unifying concept of the interrelationship formed by the SS provides an understanding of the basic concepts of the pathways of direct spread of disease and the pathogenesis of the clinical presentation of disease distant from its site of origin.

Abdomen

Mechanism of direct spread of abdominal neuroblastoma: CT demonstration and clinical implications.

Neuroblastoma, a malignant tumor of neural crest origin, is the most common extracranial solid tumor in children. In 1971 Evans et al. introduced a clinical staging for neuroblastoma. Over sixty percent of patients present with neuroblastoma beyond stage I. Despite more aggressive therapy there has been only minimal improvement in survival. Since 1978, all patients with neuroblastoma have had CT scanning as part of their initial evaluation at our institution. Children with abdominal neuroblastoma beyond stage I form the basis of this report. Selected cases illustrating the permeative nature of neuroblastoma and the mechanism of direct abdominal spread by CT scanning are presented. The tumor originates in the retroperitoneum and spreads to the abdominal aorta where it gains access to the subperitoneal space via the celiac axis and superior mesenteric artery. These vessels course from the aorta to their ultimate destination within their peritoneal folds. These folds form the interconnecting space (subperitoneal space) between the retroperitoneum and the peritoneal organs. Such scanning is extremely sensitive in detecting neuroblastoma with early infiltration into adjacent tissues and contiguous spread through abdominal spaces. The clinical implications of the permeative nature of neuroblastoma and the mechanism of contiguous abdominal spread are discussed.

Abdominal Neoplasms

The peritoneal ligaments and mesenteries: pathways of intraabdominal spread of disease.

The abdomen has been conveniently divided anatomically and clinically into specific intraperitoneal and extraperitoneal sites. A recognition of the pathways of spread and localizing features of infections, malignancies, and traumatic collections has immeasurably extended diagnostic imaging capabilities. Yet, while the abdomen may be visualized as subdivided into compartments, it must also be essentially appreciated that these compartments are an actual or potential interconnecting network. In the upper abdomen peritoneal reflections comprise 11 major ligaments and mesenteries. These are generally readily recognizable on computed tomographic scans by either their typical location and organ relationships or the landmarks provided by their major constituent vessels. These ligaments and mesenteries provide continuity of anatomic planes, which permits the spread of disease between intraperitoneal compartments, between extraperitoneal spaces, and between intraperitoneal and extraperitoneal localized sites.

Gastrointestinal Diseases

Coarctation of the midaortic arch presenting with monoparesis.

A 6 1/2-month-old infant was seen with right-arm monoparesis, right upper extremity hypertension, and findings of a coarctation located in the midaortic arch between the innominate and left common carotid arteries. Associated left cerebral atrophy (Dyke-Davidoff syndrome) was documented by computed tomography. Excision of the coarctation segment with primary repair of the arch and reanastomosis of the left carotid to the innominate artery was accomplished.

Aorta, Thoracic

Computed tomography of the subperitoneal space: demonstration of direct spread of intraabdominal disease.

The direct spread of intraabdominal disease via peritoneal folds is clearly demonstrated with computed tomography (CT). This extensive network of peritoneal folds can be conceptualized as the subperitoneal space. These subperitoneal communications within the abdomen are described and demonstrated by CT scans and a schematic drawing. Direct spread of disease within and between abdominal compartments is illustrated with selected clinical cases stressing the CT imaging method.

Abdominal Neoplasms

Computerized axial tomography of the chest for visualization of "absent" pulmonary arteries.

To expand the search for central pulmonary arteries in six patients with absence of cardiac-pulmonary continuity, computerized axial tomography (CAT) of the chest was performed. The CAT scans were compared with previous arteriograms and pulmonary vein wedge angiograms. Three patients with type IV truncus arteriosus were studied, and none had a central, right or left pulmonary artery on CAT scan. However, two patients with tetralogy of Fallot with pulmonary atresia and a patent ductus arteriosus to the right lung demonstrated the presence of a left pulmonary artery. In addition, one child with truncus arteriosus with "absent" left pulmonary artery demonstrated a left pulmonary artery on the CAT scan. The CAT scan may therefore enhance our ability to search for disconnected pulmonary arteries in children with complex cyanotic congenital heart disease.

Adolescent

Solitary hepatic cyst and benign bile duct polyp: a heretofore unheralded association.

Solitary hepatic cysts are uncommon lesions that can produce jaundice by extrinsic compression on the extrahepatic biliary tree. In two recent cases of solitary hepatic cyst with jaundice, an intraluminal polypoid adenoma that obstructed the common hepatic duct was discovered. Concurrence of these two unusual lesions suggests that they may be associated. The importance of recognizing this association is illustrated by two case reports. In case 1, extrinsic compression by the cyst on the common hepatic duct was identified as the cause of jaundice at the initial operation. In case 2, choledocholithiasis was the initial explanation for the jaundice. In both cases, palpation and exploration of the proximal bile ducts with probes and catheters failed to discover the polyp. However, jaundice persisted postoperatively in both cases, and subsequent contrast radiography revealed an intraluminal filling defect in the common hepatic duct. In both cases, reoperation was required, and a benign bile duct polyp was discovered and excised. Thus, the presence of jaundice in a patient with a cystic hepatic mass should suggest the possibility of a concurrent bile duct polyp. Awareness of this possibility should permit recognition of such a polyp at initial operation.

Adenoma

The cervicothoracic continuum.

The anatomic communications between the neck and the mediastinum are described. Anatomic sections and drawing are used to demonstrate the normal compartments, their fascial envelopes, their contained structures, and their interrelationships. Selected cases are used to illustrate the spread of pathologic processes within the cervicothoracic region.

Child, Preschool

Hemophilia-like arthropathy of the knee associated with cutaneous and synovial hemangiomas. Report of 3 cases and review of the literature.

Three patients with cutaneous and/or synovial hemangiomas demonstrated roentgenographic alterations in the knees, simulating hemophilic arthropathy. In 2 cases, unilateral synovial hemangiomas appeared to be present; in the third patient, who had bilateral abnormalities, the Kasabach-Merritt syndrome was evident, resulting in a consumption coagulopathy and hemorrhagic tendency. The pathogenesis of this unusual arthropathy is discussed.

Adult

A spectrum of renal tubular ectasia and hepatic fibrosis.

Renal tubular cystic disease and hepatic fibrosis exhibit a specific genetic pattern and pathological findings. The renal collecting tubules are dilated and the liver shows fibrosis with proliferation and dilatation of the bile ducts. The findings fall into a spectrum with marked renal disease and mild liver involvement at one end and mild renal involvement with severe liver disease at the other. Between these extremes lies an intermediate form which is genetically and pathologically similar, but exhibits a wide range of clinical and radiological findings due to the variability of renal and liver involvement.

Adolescent

Anterior extrapleural line: superior extension.

Anatomic sections of the superior aspect of the anterior mediastinum reveal that normal structures can cause indentations upon the adjacent lung. On lateral chest films, the soft-tissue density of the anterior superior mediastinal structures contrasts with that of the normal lung, revealing a normal, undulating configuration of the anterior superior mediastinum. We have termed this the "vascular incisura," analogous to the cardiac incisura of the left lung seen inferiorly. An appreciation of normal variations within this space is essential when evaluating pathologic alterations.

Adult

Metastatic carcinoma simulating inflammatory colitis.

Metastatic carcinoma to the colon may be mistaken for inflammatory colitis, particulary Crohn's disease, both clinically and roentgenologically. Characteristic changes include mucosal thickening, nodular masses, multiple and eccentric strictures, asymmetric involvement, pseudosacculations, and spiculations of contour. This report, based upon experience with 12 cases, establishes the distinctive roentgen features of metastatic disease to the colon from a variety of primary sites. It is shown that these changes are dependent upon pathways of spread, growth characteristics, and local tissue response. The clinical importance of making this differential diagnosis is two-fold. A patient with an occult or a known primary malignancy may present clinically with metastatic disease to the colon masquerading as inflammatory colitis. Recognition of the characteristic roentgenologic changes immediately either leads to a search for the primary neoplasm or establishes the diagnosis of widespread disease.

Adult