Intraperitoneal hemorrhage after renal biopsy: a grave prognostic sign.
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Biopsy↗
Biomedical subjects
R B Jeffrey
Publications and source records attributed to R B Jeffrey.
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↗
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↗
Lesions of the head and neck in patients with AIDS: CT and MR findings.
The CT and/or MR findings were reviewed in 43 patients with head and neck disease; 27 had AIDS, 14 had AIDS-related complex, and two had positive human immunodeficiency virus serologies. Fourteen patients had infections, 15 had tumors, and 15 had benign lymphoid hyperplasia. Deep cervical infections were caused by bacterial and mycobacterial organisms, including Mycobacterium avium-intracellulare. Bacterial infections were clinically more virulent than they would be in immunocompetent patients. Neoplasms included Kaposi sarcoma, lymphoma, and squamous cell carcinoma. Benign lymphoid hyperplasia demonstrated enlargement of the cervical lymph nodes, adenoids, and tonsils. Although there was considerable overlap in the imaging characteristics of the various diseases seen, several distinguishing features were noted. Cellulitis, with infiltration and thickening of the subcutaneous fat, was typical of bacterial infections, but was uncommon with tumors or mycobacterial infections. Lymph nodes with necrotic centers were seen with Kaposi sarcoma, squamous cell carcinoma, and mycobacterial infection, but not with lymphoma or benign lymphoid hyperplasia. Benign adenoidal enlargement is usually symmetric with a flat anterior border, but bulky lesions indistinguishable from tumor were seen in two patients. It is important for radiologists to be aware of the spectrum of head and neck disease in patients with human immunodeficiency virus. The CT and MR assessment can guide biopsy and assist in planning therapy.
AIDS-Related Complex↗
Gastrointestinal imaging in AIDS--abdominal computed tomography and ultrasound.
Radiologic imaging with computed tomography (CT) and ultrasound (US), when combined with guided fine-needle aspiration biopsy (FNAB) can diagnose a broad spectrum of gastrointestinal, visceral, and nodal abnormalities in AIDS.
AIDS-Related Complex↗
Computed tomography and plain film appearance of a bony sequestration: significance and differential diagnosis.
Bony sequestration has been reported in osteomyelitis, eosinophilic granuloma, and fibrosarcoma. Thirty-eight examples of radiographically apparent bony sequestra were collected to examine the validity of this differential diagnosis. Apparent sequestra were found in osteomyelitis (59%), fibrosarcoma or fibrosarcoma-like entities (13%), eosinophilic granuloma (8%), and osteoid osteoma (21%). Although osteoid osteoma does not contain a true bony sequestrum, the partially calcified nidus was radiographically mistaken for a sequestrum in eight (21%) of our cases and, therefore, should be considered when an apparent sequestrum is visualized. Computed tomography enhanced visualization of a sequestrum in 19 of 22 cases and is recommended as an adjunct to conventional radiography when the presence of a sequestrum will alter therapy.
Bone Diseases↗
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↗
Evaluation of prostate size: a comparison of ultrasound and magnetic resonance imaging.
To determine the relative accuracy of ultrasonography (US) and magnetic resonance imaging (MRI) in the evaluation of prostate volume, we compared US and MR images with surgical findings in 15 patients. Transabdominal US was excellent for determining prostate size in patients with small to moderate enlargement. When compared with surgical specimens, the difference between the weight of the gland as predicted by US and the actual weight was 14% (SD +/- 12). With the transabdominal approach, the length was often inaccurately imaged, but the addition of transrectal scans in the sagittal projection improved results: with combined transabdominal and transrectal US, the average difference in weight was 8% (SD +/- 7). The MRI more accurately predicted prostatic volume (average difference, 6% (SD +/- 6), but the difference between the latter 2 is not significant. In 5 additional patients who had undergone transurethral resection of the prostate, residual prostatic tissue was evaluated by MRI and US. In addition to demonstrating prostate size, transrectal sagittal US showed the relationship among the bladder neck, prostatic urethra, and remaining prostatic tissue. Real-time US also allowed evaluation of dynamic sphincteric contractions, which is a finding not available today with MRI. Tissue differentiation was attempted with both MRI and US. Neither imaging modality could differentiate benign from malignant disease.
Aged↗
Extensive cervical lymphadenitis due to Mycobacterium avium-intracellulare.
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Combined Modality Therapy↗
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↗
Prostatic carcinoma: staging by clinical assessment, CT, and MR imaging.
The sensitivity, specificity, accuracy, and positive and negative predictive values of clinical assessment, computed tomography (CT), and magnetic resonance (MR) imaging were compared in the differentiation of stage B from stage C prostatic carcinoma. Forty-six patients who had undergone radical prostatectomy were included in the study. Surgical-pathologic staging was considered the "truth measure." Clinical staging had an accuracy of 61%, and CT, 65%. Accuracy for MR imaging depended on the instrument parameters and plane of section used. When only transverse T1-weighted images were analyzed, MR accuracy was 61%. However, when transverse T1- and T2-weighted images supplemented by additional T2-weighted coronal or sagittal images were studied, accuracy increased to 83%. At present, MR imaging is the most accurate diagnostic modality for the local staging of carcinoma of the prostate, but for optimal results, multiple sequences and two orthogonal planes of imaging are needed.
Aged↗
Pancreatic abscess: predictive value of early abdominal CT.
The value of a recently reported grading system of early abdominal computed tomography (CT) for predicting development of pancreatic abscess in patients with acute pancreatitis was reassessed. When the previously described CT grading system was used in another patient population, it did not demonstrate the same degree of prognostic value of baseline CT. In this series pancreatic abscess occurred in only eight of 29 patients (28%) with grade E CT scans (with grade E representing the most severe involvement), compared with 60% in the previous series. Of 44 patients with either grade D or E baseline CT scans, abscesses developed in only 30%, with a minimum clinical follow-up of 3 months. A second grading system, which used a semiquantitative analysis of the degree of peripancreatic inflammation (a "CT severity score"), also did not strongly correlate with the future risk of abscess, The authors conclude that early abdominal CT should be performed selectively in patients with acute pancreatitis and reserved for patients who are either diagnostic dilemmas or who fail to respond to supportive treatment and have clinically suspected surgical complications such as pancreatic abscess.
Abscess↗
Acute suppurative tenosynovitis of the hand: diagnosis with US.
The sonographic findings in seven patients with surgically proved acute tenosynovitis of the hand (bacterial in six cases, of presumed viral origin in one) were reviewed. In the six patients with bacterial tenosynovitis the affected flexor tendon was larger than that of the contralateral normal digit. In five patients hypoechoic areas were identified surrounding the flexor tendon that proved to be pus at surgery. Sonography failed to depict a small amount of pus in the tendon sheath in one patient. The affected tendon of the single patient with tenosynovitis thought to be of viral origin was normal in size, but a focal tendon sheath fluid collection was detected that proved to be sterile at surgery. Sonography appears to be a useful imaging technique in the early diagnosis of acute suppurative tenosynovitis of the hand.
Acute Disease↗
Acute appendicitis: high-resolution real-time US findings.
High-resolution, real-time ultrasonography (US) with graded compression was used to evaluate 90 patients with clinically suspected acute appendicitis. US visualization of a noncompressible appendix was the primary criterion for a diagnosis of acute appendicitis. The overall sensitivity was 89%, the specificity was 95%, and the accuracy was 93%. When the results in women were analyzed separately (n = 49), the overall accuracy was 96%. Several important limitations of US scanning were encountered. There were three false-positive examinations in patients with a sonographically visible appendix whose symptoms spontaneously resolved. Another patient had a normal compressible appendix with a thin (2-mm), symmetric wall surrounded by ascites. There were three nondiagnostic studies (3%) due to inability to compress the cecum and right lower quadrant adequately because of exquisite tenderness (two patients) or massive ascites (one patient). When interpreted in light of the clinical examination, sonography should significantly reduce the rate of false-negative appendectomies, particularly in women.
Acute Disease↗
AIDS-related cholangitis: radiographic findings in nine patients.
Acalculous inflammation of the biliary tract is a recently reported complication of the acquired immunodeficiency syndrome (AIDS). In a 33-month period, nine men with AIDS were evaluated because of right upper quadrant and/or epigastric pain, jaundice, or abnormal liver function test results. Each patient underwent ultrasonography and endoscopic retrograde cholangiopancreatography; seven also underwent computed tomography. In eight of nine patients the imaging studies disclosed intrahepatic and extrahepatic bile duct changes identical to those seen in sclerosing cholangitis (strictures, focal dilatation, thickened duct walls). Isolated papillary stenosis and ductal dilatation were present in one patient, while eight patients had some stricturing of the distal common duct. The combination of papillary stenosis and intrahepatic ductal strictures appears unique to AIDS-related cholangitis. Endoscopic papillotomy provided variable relief to symptoms and biochemical abnormalities. Cholangitis caused by cytomegalovirus and/or Cryptosporidium infection is the proposed pathophysiologic mechanism.
Acquired Immunodeficiency Syndrome↗
Deep venous thrombosis of the lower extremity: US evaluation.
The sensitivity of duplex ultrasonography (US) for detecting deep venous thrombosis of the lower extremity was compared with that of venography in a prospective study of 54 patients. Doppler analysis of the common femoral vein and US imaging of the deep venous system from the common femoral vein to the popliteal vein was performed. Common femoral vein response to the Valsalva maneuver was recorded. Sonographically visible thrombi and abnormal vein compressibility were 91% sensitive for the common femoral vein, and 94% sensitive for the superficial femoral or popliteal veins, with no false-positive examinations. Abnormal Doppler flow and abnormal response of the common femoral vein to the Valsalva maneuver enabled thrombi to be detected only in the common femoral and iliac veins. Combined data allowed accurate diagnoses in all patients with deep venous thrombosis proximal to the deep calf veins. US should be the screening examination of choice for evaluating patients with suspected lower extremity deep venous thrombosis.
Adult↗
Aortic lacerations: fatal complications of thoracic aortography.
Traumatic aortic lacerations are life-threatening injuries that require a prompt diagnosis and surgery if patients are to survive. Most authors recommend transfemoral catheterization when performing thoracic aortography in patients with suspected aortic lacerations. The authors of this study describe two patients in whom transfemoral catheterization and contrast material injection were directly related to their deaths. These cases illustrate the need for cautious catheter manipulation in patients with aortic lacerations.
Adult↗
Percutaneous drainage of periappendiceal abscesses: review of 20 patients.
Twenty patients with periappendiceal abscesses diagnosed by CT underwent percutaneous catheter drainage. Eighteen (90%) of the 20 patients were successfully treated by percutaneous drainage and antibiotic therapy alone. In two of these patients, however, small recurrent abscesses were diagnosed by CT 4 and 6 weeks after drainage, but these abscesses resolved with additional antibiotic therapy. Surgery was performed in two patients in whom percutaneous drainage failed. One was a diabetic patient who had a gas-forming abscess that extended into the posterior pararenal space. Surgery was necessary in a second patient because of a technical failure of catheter insertion, which resulted in perforation of the abscess cavity and peritonitis. Abscess sinograms in eight (44%) of 18 patients showed fistulas between the abscess cavity and the base of the cecum or appendix. However, the fistulas did not pose a problem in clinical management, and all closed within 14 days. Percutaneous drainage is an effective alternative to surgery in selected patients with periappendiceal abscesses.
Abscess↗