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Biomedical subjects

M P Federle

Publications and source records attributed to M P Federle.

At least 19 recordsLinked to original sources
PubMed1992

Epithelioid hemangioendothelioma of the liver: imaging findings with pathologic correlation.

Hepatic epithelioid hemangioendothelioma is a rare malignant neoplasm that has nonspecific clinical signs and symptoms and can be difficult to diagnose on the basis of biopsy results. Radiologists may suggest the diagnosis of this slowly progressive neoplasm by recognizing its characteristic radiologic features. We correlated images from CT (13), sonography (nine), and MR (six) with pathologic findings in resected whole livers (eight) and biopsy specimens (five) from 13 patients 25-58 years old. Gross pathologic examination showed a repetitive pattern of multiple solid tumor nodules, in a predominantly peripheral distribution, with coalescence as individual nodules exceeded 4 cm. Tumor nodules had a hyperemic rim. Lesions adjacent to the capsule often produced capsular retraction. These findings correlated well with imaging findings. On CT, the lesions were of low attenuation, peripherally based, and with capsular retraction or flattening in nine (69%) of 13 patients. Unenhanced CT scans showed superior conspicuity over contrast-enhanced CT scans (9/13, 69%) and showed the extent of lesions more accurately in all cases (13/13, 100%). In nine patients, lesions had a peripheral enhancement pattern of alternating attenuation values correlating with the hyperemic rim at pathologic evaluation. On sonograms, the tumors were solid and predominantly hypoechoic. On MR, tumor signal was low on T1-weighted and high on T2-weighted images, with a low-signal halo present around many of the lesions. CT, sonographic, or MR findings of coalescent peripheral hepatic masses with capsular retraction are highly suggestive of hepatic epithelioid hemangioendothelioma.

Adult↗
PubMed1991

Diagnosis and staging of hepatocellular carcinoma: comparison of CT and sonography in 36 liver transplantation patients.

Radiologic studies are important in the detection of hepatocellular carcinoma and the selection of patients for partial liver resection, liver transplantation, or palliation. We retrospectively studied 36 patients with hepatocellular carcinoma who were examined with both CT and sonography before undergoing hepatic transplantation. Pathologic findings of the entire resected liver were correlated with results of imaging studies before transplantation. Parenchymal lesions were shown by sonography in 29 cases (81%) and by CT in 34 cases (94%). Although CT was more sensitive than sonography was, both CT and sonography frequently failed to depict reliably the size of tumor or the exact number of tumor nodules as determined pathologically. Pathologic findings showed vascular invasion in 19 cases (53%), whereas CT showed invasion in 11 cases (31%) and sonography showed it in only six (17%). Nodal metastasis to the porta hepatis was found in four patients; CT correctly showed two cases (three false-positive) and sonography correctly showed one case. Intrahepatic ductal dilatation was seen in eight patients on CT but was not identified on sonography. We conclude that CT is more accurate for identifying and staging hepatocellular carcinoma, but both CT and sonography frequently fail to depict the extent (size and number of lesions) of disease, especially when underlying cirrhosis is present.

Adolescent↗
PubMed1991

Imaging the hepatic transplant.

The radiologist plays a critical role in the preoperative assessment of possible hepatic transplant candidates. Any abnormality that would preclude transplantation or in some way alter the usual operative technique must be accurately documented and relayed to the surgeons. Computed tomography, duplex ultrasound, and MR imaging are the primary modalities used preoperatively. In some cases, CT performed during arterial portography is utilized to determine whether a liver transplant is necessary or whether a partial hepatic resection would suffice. Postoperatively, biliary obstruction or leakage, vascular thrombosis or stenosis, hemorrhage, and abscess formation are some of the most common potential complications seen in liver transplant patients. CT, duplex ultrasonography, and cholangiography are the mainstays in detecting post-transplant complications. The goal of the radiologist is to aid the clinician in recognizing these potential complications quickly so that operative or radiologic intervention may avoid irreversible graft dysfunction or even patient demise.

Diagnostic Imaging↗
PubMed1990

Iodinated contrast media effects on extravascular lung water, central blood volume, and cardiac output in humans.

Intravascular contrast media produce pulmonary edema in one rat model, but not in dogs or pigs. In humans, pulmonary edema after contrast media is rarely diagnosed, but subclinical edema could be more frequent than believed previously. Therefore, the authors prospectively studied the effects of diatrizoate (n = 5) and ioxaglate (n = 5) on extravascular lung water, central blood volume, and cardiac output in ten patients undergoing routine radiographic procedures. Variables were measured by thermal-dye dilution before and every 5 minutes after completion of the procedure for four repetitions. Extravascular lung water and central blood volume did not change significantly, indicating that pulmonary edema or pulmonary congestion did not occur. Cardiac output was elevated by 10.6% immediately after the procedure, but returned to baseline during the 10 following minutes. The authors conclude from this preliminary study in a small number of patients that intraarterial contrast media (less than 1.5 g/kg body weight of iodine) did not produce pulmonary edema or pulmonary congestion, even at a subclinical level.

Blood Volume↗
PubMed1989

Bowel and mesenteric injury following blunt abdominal trauma: evaluation with CT.

Computed tomography (CT) used in cases of blunt abdominal trauma has been found sensitive in detection of bowel and mesenteric injuries and discrimination of operable from nonoperable candidates. In 51 patients with suspected bowel or mesenteric injury following blunt abdominal trauma, CT correctly depicted bowel hematoma or mesenteric injury in 17 of 19 nonoperable patients (89%) and severe injuries in one patient who died preoperatively. In 26 of 28 patients who underwent therapeutic laparotomy (93%), initial CT enabled identification of surgically confirmed injuries. In two cases, initial scan misinterpretation delayed diagnosis of serious bowel injuries. The correct interpretation was rendered preoperatively and at blind retrospective review. CT findings that correlated with bowel or mesenteric injury requiring surgery were free peritoneal fluid (27 of 28, 96%), mesenteric infiltration (24 of 28, 86%), thick-walled bowel (17 of 28, 61%), associated abdominal injuries (12 of 28, 43%), and free air (nine of 28, 32%). In nonoperable cases, CT scans demonstrated bowel thickening (84%) but less frequently peritoneal fluid (21%), mesenteric infiltration (26%), or associated injuries (5%). In three of four patients who underwent nontherapeutic laparotomy, preoperative CT correctly imaged the limited abdominal injuries.

Abdominal Injuries↗
PubMed1989

Localized clotted blood as evidence of visceral trauma on CT: the sentinel clot sign.

We retrospectively reviewed the CT scans of 116 patients with abdominal trauma who had visceral injuries to determine if identification on CT of focal high-density clotted blood (a "sentinel clot") was an accurate sign of injury to an adjacent organ. The sentinel clot sign was sensitive, present in 101 (84%) of 120 visceral injuries with only three false-positive cases. Whereas CT visualized the visceral injury itself in 86% of cases, the sentinel clot was the only clue as to the source of hemorrhage in 14% of the cases. Splenic and bowel/mesenteric injuries were frequently subtle, and the focal clot helped to focus attention on the traumatic lesion. In 9% of splenic trauma cases and 32% of bowel/mesenteric injuries, the sentinel clot was the only positive finding. Localized clot is a frequent and accurate sign of injury to an adjacent organ. By facilitating diagnosis of trauma to a specific organ, it may influence the management decision of surgical vs conservative therapy.

Abdominal Injuries↗
PubMed1988

A radiologist looks at AIDS: imaging evaluation based on symptom complexes.

Many other symptom complexes could be discussed that affect virtually every organ system of patients with AIDS or ARC. While important and interesting, these are less likely to come to the attention of the radiologist for assistance in diagnosis and management. The scope of this review has also precluded discussion of infection control, although an effective plan for handling AIDS patients in a radiology department is absolutely vital. My hope is that this review will serve as a reasonable introduction or summary of the current role of the radiologist in dealing with AIDS. Obviously, new developments are coming at an extraordinary pace, and all radiologists must avail themselves of the most current sources of information.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Periappendiceal inflammatory masses: CT-directed management and clinical outcome in 70 patients.

The outcome was reviewed in 70 patients with computed tomographic (CT) and clinical evidence of periappendiceal inflammatory masses. On the basis of the initial CT scan, patients were divided into three broad categories: (a) patients with periappendiceal phlegmons or abscesses less than 3 cm (n = 32); (b) patients with well-defined and well-localized periappendiceal abscesses greater than 3 cm (n = 28); and (c) patients with extensive, poorly defined periappendiceal abscesses with either pelvic, retroperitoneal, or interloop involvement (n = 10). Thirty-two patients with either phlegmons or small abscesses were treated initially with antibiotic therapy alone; clinical resolution of the inflammatory process occurred in 28 patients (88%). Twenty-eight patients with well-defined and well-localized periappendiceal abscesses underwent percutaneous catheter drainage, which was successful in 26 patients (93%). Nine of ten patients underwent early surgical drainage for extensive, poorly defined abscesses. One patient underwent percutaneous drainage as a temporizing measure before surgery. There were three false-positive CT diagnoses of periappendiceal abscesses in this series.

Abscess↗
PubMed1988

The collapsed inferior vena cava: CT evidence of hypovolemia.

In a review of 100 patients undergoing abdominal CT for blunt abdominal trauma, seven had flattening of the infrahepatic inferior vena cava at multiple levels. In six of these patients, emergency surgery was required to control major hemorrhage. Three patients had hypotension documented during or shortly after abdominal CT. Five patients had major intraabdominal injuries, and one patient had massive hemorrhage from facial lacerations. The severity of the blood loss was not fully appreciated clinically in five of the six patients before CT. The seventh patient had no clinical evidence of significant blood loss; in this case the flattened inferior vena cava probably was related to a normal variant. In a group of 100 patients scanned for nonacute conditions, none had flattening of the infrahepatic inferior vena cava at multiple levels. Presence of a collapsed inferior vena cava may be CT evidence of significant hypovolemia from major blood loss and should prompt careful hemodynamic and central venous pressure monitoring.

Abdominal Injuries↗
PubMed1988

CT of small pyogenic hepatic abscesses: the cluster sign.

Of 36 consecutive patients with pyogenic liver abscesses evaluated by CT, five (14%) had multiple small abscesses less than 2 cm in size. The CT appearance of the small pyogenic abscesses was compared with that of 10 patients who had either fungal or mycobacterial abscesses and with that of 50 patients who had hepatic metastases. In all five patients who had small pyogenic abscesses, the abscesses appeared to cluster, or aggregate, in a pattern that suggested the beginning of coalescence into a single, larger abscess cavity (cluster sign). This cluster appearance was not seen in in any of the patients who had fungal or mycobacterial microabscesses. It was present in only one of the patients who had confirmed hepatic metastasis. Despite the small size of the abscesses, guided needle aspiration was successful in recovering pyogenic organisms in four of the five patients. In our experience, the presence of the cluster sign suggests that the lesions are pyogenic abscesses.

Adolescent↗
PubMed1988

CT of peritoneal lymphomatosis.

The CT and clinical findings are presented in seven patients with diffuse peritoneal malignancy caused by non-Hodgkin lymphoma. All seven patients had CT evidence of ascites, omental infiltration, and peritoneal implants mimicking carcinomatosis. Bulky retroperitoneal or mesenteric adenopathy was present in only one patient. Four of the seven patients had documented AIDS. Paracentesis provided a diagnosis of lymphoma in only one of the seven patients. In the other six patients, the final diagnosis was established by surgery (three patients), by autopsy (one patient), by laparoscopy (one patient), and by guided needle aspiration (one patient). Although uncommon, lymphoma should be considered in patients who have diffuse peritoneal malignancy, particularly those who are at risk for AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Improved survival with early CT diagnosis of pancreatic abscess.

Until recently pancreatic abscess was often a lethal complication of acute pancreatitis. A major factor contributing to this high mortality has been delay in diagnosis. When combined with diagnostic needle aspiration, computed tomography (CT) has greatly enhanced the early detection of pancreatic abscesses. In the past 5 years at our institutions 23 patients with proven pancreatic abscesses were evaluated early in their clinical course by CT. In follow-up ranging from 4 months to 4 1/2 years there were only 4 deaths: a mortality rate of 17%. Many of the surviving patients had a long and protracted clinical course (mean length of hospitalization, 58 days) and reoperation for recurrent abscess or gastrointestinal complications was required in 9 patients (39%). Computed tomography proved helpful both in localizing the site of de novo or recurrent pancreatic abscess and in detecting postoperative complications. An aggressive approach to early CT scanning with diagnostic needle aspiration appears to be a factor in the improved survival of these patients.

Abscess↗
PubMed1987

Computerized tomography in bladder rupture: diagnostic limitations.

Because computerized tomography is often the first test performed in patients with blunt abdominal and pelvic trauma we designed a prospective study to determine if it might be as accurate as retrograde cystography in the diagnosis of bladder rupture. Patients who had suffered blunt trauma with gross hematuria or who had pelvic fractures and microhematuria underwent computerized tomography followed by retrograde cystography. A urethral catheter was inserted and clamped during computerized tomography to ensure bladder filling. Of our first 2 patients computerized tomography showed no evidence of opacified urinary extravasation in 1 and only subtle evidence in the other. Cystography revealed gross intraperitoneal extravasation of opacified urine in both patients. Presently, retrograde cystography, including a film of the distended bladder and a drainage film, remains the most reliable test in suspected bladder rupture.

Adult↗
PubMed1987

Computed tomography in the diagnosis of blunt intestinal and mesenteric injuries.

Twenty-four patients with signs on computed tomography (CT) of mesenteric or intestinal injury were treated over a 5-year period (1980-1984). All patients were the victims of blunt abdominal trauma. Nine patients with CT evidence of mesenteric or bowel hematomas were observed without adverse outcome. Fifteen were operatively explored, with 14 having injuries similar to the findings on the preoperative CT scans. In the group that had surgery, either thickened bowel or free intraperitoneal fluid (blood or less dense fluid) or both were present in all but one patient. Extraluminal air (three cases) or Gastrografin (Squibb) (one case) were absolute indications for surgery, as were bowel wall or mesenteric hematomas accompanied by substantial amounts of intraperitoneal fluid. The patient's history, physical examination, and initial laboratory values are important in proper selection of patients for CT evaluation. We feel that CT appears to offer certain definite advantages over peritoneal lavage in evaluation of bowel and mesenteric injuries and can reliably help to distinguish the injuries that require surgical repair from those that can be safely monitored and observed.

Abdominal Injuries↗
PubMed1987

Splenic trauma: evaluation with CT.

Fifty-five consecutive cases of surgically proved splenic injuries were evaluated with computed tomography (CT). CT permitted correct identification of 54 splenic injuries, with one false-negative and three false-positive cases. In the single false-negative case and in two of the three false-positive cases, CT scans correctly indicated the presence of a large hemoperitoneum and other abdominal visceral lacerations and so correctly indicated the need for surgery. Of the 55 proved cases, CT demonstrated hemoperitoneum in 54 (98%), perisplenic clot in 47 (85%), splenic laceration in 39 (71%), and subcapsular hematoma in 13 (24%). Perisplenic clot can be distinguished from lysed blood in the peritoneal cavity and is a sensitive and specific sign of splenic trauma, even in the absence of visible splenic laceration. The authors conclude that CT is a highly reliable means of evaluating splenic trauma.

Adolescent↗