Gallbladder sludge and antibiotics.
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Ceftriaxone↗
Biomedical subjects
S A Teefey
Publications and source records attributed to S A Teefey.
Differentiating pelvic veins and enlarged lymph nodes: optimal CT techniques.
A study was done to find the best technique of administering contrast material intravenously to enable differentiation of pelvic veins and enlarged lymph nodes on computed tomographic (CT) scans. Seventy-eight patients with suspected pelvic malignancies were evaluated with CT. After precontrast scans were obtained at a selected pelvic level, 150 mL of contrast material was injected as a two-phase bolus; images were obtained at the same level 1.5, 3, 5, and 7 minutes after initiation of the bolus. Mean pelvic venous enhancement was maximal between 3 and 7 minutes in all the patients. Venous attenuation changes did not correlate with the presence of cardiac or peripheral vascular disease, but there was significantly less enhancement in patients with diabetes mellitus. The time of maximum vein enhancement begins at 3 minutes and continues for at least 4 minutes. A delayed technique of scanning the pelvis may be preferable to rapid scanning to optimize enhancement of the pelvic veins.
Adult↗
CT of the extrahepatic bile ducts: wall thickness and contrast enhancement in normal and abnormal ducts.
Recent reports have described thickening and enhancement of the extrahepatic bile duct wall on CT scans obtained after administration of IV contrast material. We undertook this study to establish parameters for the normal thickness and enhancement of the bile duct wall on CT, and to develop a differential diagnosis for thickening of the duct wall. Routine CT examinations of 100 patients without biliary disease were evaluated prospectively. The common hepatic duct and common bile duct could be visualized in 66% and 82% of cases, respectively; the walls of these ducts could be separately discerned in 59% and 52%. The mean thickness of the duct wall was 1 mm, with a maximal thickness of 1.5 mm. Wall enhancement was similar to (51%), slightly greater than (44%), or markedly greater than (5%) the enhancement of adjacent pancreatic parenchyma. A review of records covering a 5-year period identified 52 patients in whom CT showed thickening of the bile duct wall (greater than or equal to 2 mm). These patients could be categorized by seven underlying diseases, and analysis of the CT scans revealed four general patterns of thickening. Focal, concentric wall thickening in the distal common bile duct was associated with pancreatitis, pancreatic cancer, and common bile duct stones; focal, eccentric thickening tended to occur with cholangiocarcinoma and sclerosing cholangitis. Diffuse, concentric thickening was seen with acute cholangitis; diffuse, eccentric thickening was associated with oriental cholangiohepatitis and sclerosing cholangitis. Thickening of greater than 5 mm was seen only with cholangiocarcinoma. Enhancement of the duct wall in these groups varied and was of no predictive value. In summary, the extrahepatic bile ducts can be visualized in the majority of patients, and the normal duct wall should be 1.5 mm or less in thickness. Contrast enhancement of the duct wall occurs in patients without biliary tract disease and alone is predictive not predictive of pathology. Pancreatitis, pancreatic cancer, common bile duct stones, cholangiocarcinoma, sclerosing cholangitis, acute cholangitis, and oriental cholangiohepatitis are associated with thickening of the duct wall.
Acute Disease↗
Sclerosing cholangitis: CT findings.
The value of computed tomography (CT) in the detection of primary sclerosing cholangitis (PSC) in the intrahepatic and extrahepatic biliary systems was assessed by comparing CT scans of 20 cases of PSC with cholangiographic findings. In 16 of 19 cases of extrahepatic duct disease demonstrated with cholangiography, CT demonstrated abnormalities of the common hepatic duct, or bile duct, including duct stenosis, mural nodularity, duct dilatation, wall thickening, and mural enhancement. CT demonstrated intrahepatic disease in all 20 cases, including duct dilatation, duct stenosis, pruning, and beading. CT was superior to cholangiography in characterization of the status of the intrahepatic duct system in 11 of 20 cases. In addition, CT demonstrated extrabiliary complications of PSC in 12 cases and superimposed cholangiocarcinoma in three cases. While cholangiography remains the standard for diagnosis and follow-up of PSC, CT can provide valuable information about the extent and complications of the disease.
Adult↗
CT evaluation of gallstones in vitro: correlation with chemical analysis.
With the advent of chemical dissolution and lithotripsy for the treatment of gallstones, use of imaging techniques to determine the chemical composition of gallstones has become important. In vitro CT scans were performed on gallstones removed at surgery from 70 patients. The CT appearances were as follows: dense (20%), faint (10%), isodense with saline (nonvisualized) (26%), rimmed (30%), and laminated (14%). Stones from 50 patients were subjected to chemical analysis, and the results were compared with the appearance of the stones on CT. Among stones grouped by CT appearance, a significant difference in cholesterol content was found, but calcium content did not differ significantly among most groups. The inverse correlation between CT attenuation values and cholesterol was stronger (r = -.82) than the correlation between CT attenuation values and calcium (r = .64). The results show that gallstones can be divided into those with high cholesterol content and those with low cholesterol content on the basis of their appearance on in vitro CT. The differences in the CT findings in many gallstones appear to relate more to cholesterol content than to calcium composition.
Bilirubin↗
Sonographic diagnosis of neutropenic typhlitis.
Five immunosuppressed patients with neutropenic typhlitis were studied with sonography. In four, sonography was the imaging technique that first suggested the diagnosis. In each case, sonography showed thickening of the right colon wall (1-2.5 cm) with low- or high-level echoes. Serial sonograms were used to monitor the daily progress of the disease in two patients. Sonography appears to be a useful tool not only to detect typhlitis in patients with symptoms suggestive of the disease, but also to follow their clinical course.
Adult↗
Calcification in hepatocellular carcinoma: not always an indication of fibrolamellar histology.
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Calcinosis↗
Sonographic evaluation of pericholecystic abscess with intrahepatic extension.
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Aged↗
CT appearance of primary pancreatic lymphoma.
Primary lymphoma of the pancreas is a rare neoplasm that may resemble pancreatic carcinoma on CT scans. Two cases with CT findings are presented.
Adenocarcinoma↗
Computed tomography and ultrasonography of hepatoma.
Computed tomography (CT) scans and sonograms of 37 patients with hepatocellular carcinoma (hepatoma) were reviewed to determine the characteristics of the tumour and to compare the modalities in terms of accuracy in defining tumour morphology and ability to predict vascular invasion and extrahepatic spread. By CT, slightly over 50% of the tumours were multicentric, about 40% were solitary, and the rest were diffuse. About half of the hepatomas were heterogeneous in density before injection of contrast agent and most became enhanced in a non-uniform manner. In addition, about a quarter of the tumours either became visible or were better seen after injection of contrast agent. At sonography, approximately two-thirds of the neoplasms were thought to be solitary and one-third multicentric. The majority also had a mixed echo texture. Although the lesion was identified in all 13 patients who had both studies, sonography underestimated the extent of hepatic involvement in 38% of the cases. Sonography also failed to demonstrate lymphadenopathy that was detected by CT in two patients. In general, both techniques were effective in identifying vascular invasion. CT was very accurate in showing the extent of hepatic involvement but was unable to identify direct invasion of neighbouring structures. Because each technique has limitations in the evaluation of hepatoma, we believe that both should be performed if curative resection is being considered.
Adult↗
The fluoroscopic barium enema in colonic polyp detection.
The results of 1,500 barium enema studies done by vigorous manual palpation under fluoroscopy were reviewed to determine the adequacy of this technique in detecting polyps above the proctoscopic level. Of the 1,500 patients examined, 103 (7%) were diagnosed radiographically as having a total of 149 polyps. Polyps were found at proctoscopy in about 10% of the 1,500 patients. Colonoscopy or surgery was performed on 35 of the 103 patients. Of the 52 polyps discovered during these procedures, only three were missed at fluoroscopic barium enema study, a false-negative rate of 6%. Fourteen patients whose barium enemas initially were reported as negative for polyps or neoplasia had colonoscopy. Two of the 14 patients had positive findings, for a true-negative rate of 86%. If the detection rate of 7% found at barium enema, taking into account an overlap of 10%, is combined with the rate of 7.5% found at proctoscopy, a frequency of about 14% emerges in detecting polyps in the rectum and in the colon. Thus, the fluoroscopic barium enema when combined with proctoscopy is a sensitive method in the detection of colorectal polyps. In addition, it has the advantage of rapid execution and relatively low cost.
Barium Sulfate↗
Factors affecting image quality and diagnostic efficacy in abdominal sonography: a prospective study of 140 patients.
A study was undertaken to evaluate the limitations of abdominal sonography in a group of predominantly elderly patients. In the majority of patients (98%) sonography, using 3.5 MHz and 5 MHz array transducers permitted visualization of the major abdominal organs with image quality sufficient for definitive diagnosis, but improved image quality would be desirable in 78% of this sample. Obesity and immobilization were associated with poor sonographic image quality. In 31 of the 45 (69%) poor image quality studies, no near-field artifacts (less than 3 cm depth) were observed. Obstacles in the acoustic path were noted in 77% of the poor image quality studies.
Abdomen↗
Gallbladder sludge formation after bone marrow transplant: sonographic observations.
We prospectively studied 12 patients before and after bone marrow transplantation (BMT) with serial sonography to evaluate gallbladder sludge formation. Patients were studied on four separate occasions to assess the gallbladder for sludge and stones: prior to BMT and conditioning chemoradiation, and on days 3, 13, and 28 after BMT. During two of the sonographic studies, gallbladder volume measurements were made before and after administration of cholecystokinin octapeptide (CCK-OP) and the ejection fraction (EF) was calculated. Medical records were reviewed for symptoms of cholecystitis, narcotic use, and dietary intake. Sludge and/or stones developed in eight of 12 patients (67%), and in four patients sludge was observed by day 3 post-BMT. Ejection fraction was normal (> 50%) pre-BMT in six of the eight patients who developed sludge, and in four of these six post-BMT. Furthermore, five of the eight patients developed sludge and/or stones in the absence of fasting and/or narcotic use. We conclude that gallbladder sludge develops frequently and early in BMT patients and may resolve or progress to stone formation. We did not demonstrate a relationship between impaired contractility and the development of sludge and/or stones, nor did we find a strong association between sludge formation and conditions presumed to cause gallbladder stasis, such as narcotic use and fasting. These findings suggest that other factors apart from impaired gallbladder contractility may play a role in the formation of sludge in the BMT patient.
Adult↗
Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically.
The purpose of this study was to examine longitudinally the natural history of asymptomatic rotator cuff tears over a 5-year period and to assess the risk for development of symptoms and tear progression. Since 1985 through the present, bilateral sonograms were done on all patients. A review of consecutive sonograms done from 1989 to 1994 revealed 58 potential patients with unilateral symptoms who had contralateral asymptomatic rotator cuff tears. Of these 58 patients, 45 (22 men, 23 women) responded to a comprehensive questionnaire and 23 additionally returned for examination and repeat sonographic evaluation. The questionnaire was based on the American Shoulder and Elbow Surgeons score and included several outcome-based questions. A physical examination was performed in a standardized fashion along American Shoulder and Elbow Surgeons guidelines. Repeat high-resolution sonograms were performed by a single experienced radiologist. Primary and repeat sonograms were then reassessed for tear size and location by two independent experienced radiologists blinded to the clinical data results. Twenty-three (51%) of the previously asymptomatic patients became symptomatic over a mean of 2.8 years. The average Activities of Daily Living score for those remaining asymptomatic was 28.5 of 30 and for those becoming newly symptomatic, 22.9 of 30 (P <.5). The mean visual analog pain score (1 = no pain) for those remaining asymptomatic was 1.1 and for the newly symptomatic patients, 4.0. Of the 23 patients who returned for ultrasound, 9 were asymptomatic and 14 symptomatic. Only 2 of the 9 patients remaining asymptomatic had progression of their tears. Overall, 9 of 23 patients had tear progression. No patient had a decrease in the size of the tear. Our results demonstrate that symptoms can develop in patients with previously asymptomatic rotator cuff tears when seen in the context of a contralateral symptomatic tear. Development of symptoms was associated with a significant increase in pain and decrease in the ability to perform activities of daily living (P <.05). There appears to be a risk for tear size progression over time.
Activities of Daily Living↗
CT manifestation of neutron radiotherapy-induced changes in lung.
Sixty-nine chest CT studies of 36 patients with lung cancer were obtained at various times (21 to 649 days) following completion of fast neutron radiotherapy. Multiple scans (2 to 7) were available in 16 cases. Fractionated neutron radiotherapy was delivered over four to seven weeks to a total dose of 60 to 67 Gy photon equivalent. Parenchymal change within the lung was noted in 43% by 12 weeks, in 91% between 12 and 24 weeks, and in 100% after 24 weeks. Three different patterns of lung parenchymal change were evident. Ectatic air-filled bronchi were observed in more than 50% after 24 weeks. Mediastinal shift and thoracic shrinkage were demonstrated in six and three cases, respectively. Serial CT scans revealed that lung parenchymal changes usually became stable or shrunk after 36 weeks. The possible effect of chemotherapy (mitomycin-C, vinblastin and cis-platinum), in 19 of these patients is also discussed.
Adult↗