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P Touliopoulos

Publications and source records attributed to P Touliopoulos.

5 recordsLinked to original sources
PubMed1997

Medial border of the perirenal space: CT and anatomic correlation.

PURPOSE: To explore the mode of spread of disease between the perirenal space and the perivascular central retroperitoneum and to determine the anatomy along the medial border of the perirenal space. MATERIALS AND METHODS: Anatomic dissection, injection of latex, and observation of cross sections of the abdomen were performed in nine cadavers. Attention was paid to the juncture of the central prevertebral, perivascular, and extraperitoneal regions, and the perirenal space. Anatomic findings were correlated with observations made at computed tomography (CT) in 82 patients with retroperitoneal hemorrhage (n = 24), inflammation (n = 37), and neoplasia (n = 21) involving the perirenal spaces or the central retroperitoneum. RESULTS: Along most of the length of each kidney, no apparent fascia separates the perirenal space from the central retroperitoneum. At this location, septa between fat lobules form a fenestrated multitier barrier. These septa were imperceptible on CT scans obtained in healthy individuals. After injection of latex in cadavers, this potential barrier was seen. In the clinical study, spread of disease was allowed in only 38 (30%) of 128 instances of potential spread. Spread was facilitated along the renal vessels and the interlobular septa. CONCLUSION: Beyond the kidneys, the renal fascia is closed, forming a cone superiorly and an inverted cone inferiorly. A network of interlobular septa acted as a barrier or pathway to the free spread of disease from the perirenal space to the central retroperitoneum or from the central retroperitoneum to the perirenal space.

Adult↗
PubMed1995

Why perirenal disease does not extend into the pelvis: the importance of closure of the cone of the renal fasciae.

OBJECTIVE: The prevailing concept is that lack of fusion of the anterior and posterior renal fasciae caudally (an open cone) allows free communication between the perirenal space and the extraperitoneal portion of the pelvis. However, perirenal disease rarely extends into the pelvis and an open cone has not been observed on CT scans. Accordingly, we determined the anatomy of the caudal extent of the cone of the renal fasciae in cadavers and on CT scans. MATERIALS AND METHODS: Anatomic dissections of the lower portion of the retroperitoneum and the extraperitoneal portion of the pelvis were made in eight cadavers. Two cadavers were intact, two had colored latex injected into the perirenal space before dissections, and the abdomens and pelves of four were sectioned transversely in 3- to 5-cm-thick slices. The renal fasciae were traced on transparent films placed on the cross sections, and computer-generated three-dimensional representations of the tracings were made. These anatomic findings were correlated with observations made on CT scans of 59 consecutive patients with diseases involving the lower part of the retroperitoneum and the extraperitoneal portion of the pelvis (32 patients with hemorrhage, 16 with inflammatory processes, and 11 with neoplastic conditions). RESULTS: The anatomic study showed that the anterior and posterior renal fasciae merge to form a single multilaminar fascia in the iliac fossa. Anteriorly, this common fascia is loosely connected to the parietal peritoneum. Posteriorly lies the caudal continuation of the posterior pararenal compartment. This joins with the laterocaudal continuation of the central part of the retroperitoneum, which contains the iliac vessels. The distal part of the ureter lies within the caudal continuation of the single multilayered renal fascia. The CT studies done in patients showed that extension of the perirenal processes to the pelvis and vice versa was both restrained and uncommon: no direct extension of any abnormalities was observed in either direction, and laminar thickening of the fasciae was seen in one fifth of the patients. Similarly, no inferior communication of the perirenal space with the anterior or posterior pararenal spaces was seen. CONCLUSION: There is an anatomic barrier between the inferior perirenal space and the extraperitoneal pelvis formed by the fusion of the leaves of the renal fasciae into a single multilaminar fascia that acts as a barrier of disease extension. The multilaminar nature of this fascia, however, may also act as a filter, allowing some permeability between its layers. This potential interlaminar pathway is rare and is manifested as fascial thickening on CT scans. This laminar filter-barrier observation explains the lack of extension of perirenal diseases into the pelvis.

Adult↗
PubMed1995

Helical (spiral) CT of the thorax.

Helical CT should be used routinely for thoracic imaging both as a primary screening tool in patients assessed for metastatic disease or lung cancer and as a problem solving modality in more complex lesions (e.g., arteriovenous malformations). Greater confidence in diagnosis and improved accuracy of lesion detection are benefits resulting from the volumetric data acquisition of helical CT. Optimal use of intravenous contrast material during a short scan interval enhances the diagnosis of pulmonary thromboembolic disease and aortic pathology. The airways can be displayed in detail on axial, coronal, or minimum intensity projection images, which is useful when planning interventional or surgical procedures.

Adult↗
PubMed1993

Demonstration of unilateral sialadenitis on postradiotherapy gallium-67-citrate imaging.

Intense, asymetric uptake of 67Ga-citrate in the right parotid and submandibular glands was observed in an asymptomatic patient who had undergone locoregional radiotherapy for Stage IA Hodgkin's disease 8 mo earlier. In view of the modified minimantle radiation field and adjunctive 99mTc salivary imaging, a unilateral radiation-induced sialadenitis best explained this unusual scintigraphic appearance.

Aged↗