Intravascular injection of iodinated contrast media.
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Biomedical subjects
Publications and source records attributed to N S Curry.
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A common problem in radiologic and urologic practice today is what to do with the small or indeterminant renal mass. Whether found incidentally or sought after because of patient symptomatology, these lesions present a challenge in diagnosis and management. This article outlines the scope of the problem, illustrates representative lesions, suggests imaging and management strategies culled from personal experience, and provides a review of available literature.
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The current use of CT and sonography for a wide variety of indications has led to the frequent incidental discovery of small (1.5-3.0 cm) and very small (< 1.5 cm) lesions in the renal parenchyma. These lesions are usually small benign cysts, complicated cysts, or small neoplasms. Although the increased sophistication of imaging technology has certainly improved the detection of these lesions, a specific diagnosis can be elusive, and management is controversial. The question remains as to whether lesions that prove to be neoplasms warrant treatment or whether they are clinically insignificant and should be ignored. The radiologist plays a major role in making this decision. The purpose of this article is to review the literature regarding the etiology and imaging evaluation of small renal lesions and to make recommendations for their appropriate management.
Myelolipoma is a benign tumor composed of mature adipose tissue and hematopoietic elements. Although they are most commonly found in the adrenal glands, extra-adrenal myelolipomas are well documented. We describe a case of myelolipoma arising within or adjacent to the spleen of a patient with sickle cell disease. This encapsulated tumor contained myeloid and adipose components, as well as clear cells resembling adrenal cortical tissue. Although ectopic adrenal tissue has not been reported in the spleen, we feel that this is the most likely site of origin of this mass. To our knowledge, this is the first instance of this neoplasm presenting as a splenic mass. The possible pathogenesis and etiology of this unusual lesion is discussed.
With the routine use of computed tomographic imaging, intrinsic involvement of the genitourinary tract in newly diagnosed non-Hodgkin's lymphoma is seen in as many as 10 percent of patients. Incidental discovery of an extranodal, extra-lymphatic lesion in the genitourinary tract without clinical or radiographic evidence of disease elsewhere, however, is an uncommon occurrence. The clinical presentation and imaging findings in 4 patients with initial manifestation of lymphoma isolated to the kidney, ureter, bladder, and adrenals, respectively, are presented. These patients had no evidence of lymphoma elsewhere, and imaging studies mimicked the more common neoplasms affecting these organs.
Cystic pheochromocytomas are unusual variants of adrenal pheochromocytomas. Computed tomography and pathologic findings in the two cases reported here illustrate three cardinal principles in the diagnosis of cystic pheochromocytomas: (1) A suprarenal cystic tumor discovered on CT may be the result of hemorrhage and necrosis of an adrenal pheochromocytoma. (2) The cystic pheochromocytoma typically exhibits areas of low attenuation, with Hounsfield units in the range of 5 to 15 and rim enhancement on contrast administration. (3) Incidental adrenal lesions with these features discovered on CT scanning are an indication for catecholamine assays to screen for pheochromocytoma.
Three families affected by the rare genetic disorder orofaciodigital syndrome, type I (OFD-1) were screened by computed tomography (CT) to determine the presence of cysts in the kidneys and liver, an association known to occur but not previously described in the radiologic literature. Renal cystic changes in four females with oral, facial, and digital malformations were variable and not distinguishable from other inherited cystic kidney diseases. One patient had biliary ectasia and hepatic cysts. "Polycystic" kidneys occurring only in female members of a family should suggest OFD-1, an X-linked dominant disorder that is lethal in utero in males. Patients known to have the syndrome should be screened for cystic renal disease.
Three cases of fatality related to the use of low-osmolality contrast material (LOCM) are presented. LOCM definitely reduces unpleasant side effects and serious reactions, but data are currently insufficient to determine whether the death rate is any different from that associated with high-osmolality contrast agents. If the present trend toward universal conversion to LOCM continues, an enormous cost for little, if any, lifesaving benefit may be incurred.
A case of bilateral fallopian tube filling defects found on hysterosalpingography performed on a patient for infertility work-up is presented. Repeat hysterosalpingography performed 4 years later showed no change. Microsurgical resection revealed the defects to be fallopian tubal polyps of endometrial origin.
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Computed tomographic scans of the pelvis that demonstrate anterolateral "pointing" of the urinary bladder suggest the possibility of inguinoscrotal herniation (scrotal "cystocele"), a rare but clinically relevant condition if it is not recognized preoperatively.
Isolated congenital macrodactyly, termed macrodystrophia lipomatosa, is a rare entity. It may be confused with plexiform neurofibroma, hemangioma, or lymphangioma. Computed tomography provides an ideal methodology to verify the fatty proliferation of soft tissue that accompanies bone overgrowth and distinguishes this lesion from the others in the differential list.
Small-bore, silicone nasoenteric feeding tubes are increasingly utilized in the critically ill patient to provide nutritional support. The metallic-weighted tips and stiffening introducing stylets create the potential for misplacement with potentially serious consequences. We have reported our experience with 14 patients who had inadvertent tube misplacement, resulting in complications that included pneumothorax, hydrothorax, empyema, mediastinitis, pneumonia, and esophageal perforation. The incidence of radiographically detected abnormal tube position was 1.3 percent. The presence of cuffed tracheostomy or endotracheal tubes did not prevent this occurrence. The institution of enteral feedings should, therefore, be performed according to strict guidelines which include radiographic confirmation of desired position before feedings are initiated, limited and supervised use of stylets, and a need for special precautions in patients who are obtunded or receiving intubated respiratory assistance.