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S E Rubesin

Publications and source records attributed to S E Rubesin.

At least 91 records · Page 5Linked to original sources
PubMed1990

Update on esophageal radiology.

This article reviews the current status of double-contrast radiography in diagnosing pharyngeal tumors and opportunistic esophagitis and the radiologic evaluation of esophageal motility disorders in patients with chest pain. Double-contrast pharyngography is a valuable technique for detecting pharyngeal tumors. These lesions may be manifested by an intraluminal mass, mucosal irregularity, or asymmetric distensibility. Furthermore, barium studies may demonstrate lesions involving the valleculae, tongue base, lower hypopharynx, and pharyngoesophageal segment that are difficult to visualize at endoscopy. Double-contrast radiography is also a valuable technique for detecting opportunistic esophagitis and for differentiating the underlying causes. Mucosal plaques should suggest Candida esophagitis, whereas discrete ulcers should suggest herpes esophagitis, and one or more large, relatively flat ulcers should suggest cytomegalovirus esophagitis. Finally, in evaluating patients with chest pain, in only a small percentage are esophageal motility disorders found to be a possible cause of their pain. Instead, the majority are found to have cardiac disease, structural esophageal lesions, or gastroesophageal reflux, so that barium studies are more useful in documenting normal motility or structural abnormalities in these patients.

Esophageal Motility Disorders↗
PubMed1989

Atrophic gastritis in pernicious anemia: diagnosis by double-contrast radiography.

A retrospective study was performed to determine whether the areae gastricae pattern in the stomach or other radiologic features could be used on double-contrast upper gastrointestinal examinations to accurately diagnose atrophic gastritis in pernicious anemia. The double-contrast studies from 21 patients with pernicious anemia and 55 age-matched controls were interspersed and reviewed blindly to assess gastric size, mucosal folds, and the areae gastricae pattern in the stomach. The best set of criteria for differentiating the pernicious anemia group from the controls included a fundal diameter of 8 cm or less, absent mucosal folds in the fundus or body, and small (i.e., 1-2 mm in size) or absent areae gastricae. This combination of findings was present in 81% of patients with pernicious anemia but it also was present in 11% of the controls, so that atrophic gastritis in pernicious anemia could not be reliably diagnosed on radiologic criteria. Nevertheless, patients with pernicious anemia invariably had small or absent areae gastricae in the stomach, so that the presence of prominent areae gastricae, particularly in the fundus, may be a useful criterion for excluding this disease.

Anemia, Pernicious↗
PubMed1989

Adult celiac disease and its complications.

Classic radiographic findings described in adult celiac disease--lumen dilatation, flocculation of barium, hypersecretion, thickening of folds--are nonspecific or are secretion related artifacts. The small bowel enema technique and CT make it possible to demonstrate specific diagnostic features of the disease and its complications. This substantially modified approach to the diagnosis of adult celiac disease is presented together with correlative pathology. Examples of the complications of celiac disease--ulcerative jejunoileitis, lymphoma, hyposplenism, carcinoma, and the cavitary lymph node syndrome--are illustrated.

Adult↗
PubMed1989

Pseudomembranous colitis with rectosigmoid sparing on barium studies.

The classic description of pseudomembranous colitis on barium enema studies is that of pancolitis with thickened haustral folds, a shaggy luminal contour, and/or mucosal plaques. However, the authors describe six patients with proved pseudomembranous colitis in whom barium studies (four double-contrast barium enema studies, one single-contrast barium enema study, and one peroral pneumocolon study) demonstrated rectosigmoid sparing with proximal colitis extending from the cecum to the sigmoid colon (three cases) or to the descending colon (three cases). In all six cases, endoscopy revealed a normal rectum or mild, nonspecific proctosigmoiditis without evidence of pseudomembranes in the rectosigmoid colon. Four patients had an atypical clinical presentation with bloody diarrhea (three cases) or minimal mucous diarrhea (one case). Thus, the diagnosis of pseudomembranous colitis may initially be suggested on barium studies in patients who have relative sparing of the rectosigmoid colon with characteristic findings more proximally in the colon.

Barium Sulfate↗
PubMed1989

Bowler-hat sign: a simple principle for differentiating polyps from diverticula.

The bowler-hat sign has been described both with colonic polyps and with diverticula. The authors describe a simple principle for evaluating a bowler-hat sign in order to determine whether it is caused by a polyp or a diverticulum. If the bowler hat points toward the center of the long axis of the bowel, it represents an intraluminal structure (ie, a polyp). If, however, it points away from the center of the long axis of the bowel, it represents an extraluminal structure (ie, a diverticulum). Only if the bowler hat is located in the midline or is directly parallel to the long axis of the bowel is it impossible to classify the abnormality as a polyp or a diverticulum. The value of this principle was confirmed with both a radiographic model and a blinded review of radiographs from 37 cases demonstrating the bowler-hat sign. When a bowler hat is present on a double-contrast barium enema examination, use of this principle provides a simple and objective means of differentiating a polyp from a diverticulum.

Barium Sulfate↗
PubMed1989

Rectal involvement by prostatic carcinoma: barium enema findings.

A retrospective study was performed to determine the radiographic features of prostatic carcinoma invading the rectum on double-contrast barium enemas. In 11 such patients, these examinations revealed localized narrowing and/or speculation of the rectum (four cases); a smooth, extrinsic mass impression on the rectosigmoid colon (two cases); an umbilicated submucosal mass in the rectosigmoid colon (one case); and rectosigmoid narrowing with spiculated, pleated mucosal folds in the narrowed segment of bowel (four cases). Thus, most patients (64%) had localized involvement of the rectosigmoid colon with sparing of the distal rectum. The anatomic-pathologic basis for the localized spread of prostatic carcinoma to the rectosigmoid colon is illustrated on MR scans. Thus, prostatic carcinoma invading the rectum may be manifested on double-contrast barium enema by a spectrum of radiographic findings, and most patients have localized rectosigmoid involvement with sparing of the distal rectum.

Adenocarcinoma↗
PubMed1989

Pseudoaneurysm of common iliac artery mimicking colonic metastasis on double-contrast barium enema.

We describe a patient with a pseudoaneurysm of the right common iliac artery that on a double-contrast barium enema mimicked the appearance of metastatic tumor involving the sigmoid colon, including a mass effect and spiculated, tethered mucosal folds. In the appropriate clinical setting, computed tomography, magnetic resonance imaging, and aortography help to distinguish a pseudoaneurysm from metastatic tumor involving the bowel.

Aneurysm↗
PubMed1988

Gastric ulceration caused by heater probe coagulation.

A double-contrast upper gastrointestinal examination on a woman who had undergone endoscopic heater probe therapy one day earlier for multiple arteriovenous malformations revealed shallow, irregular, and linear ulcers at the sites of heater probe coagulation. Multiple shallow ulcers may therefore develop as a direct complication of heater probe therapy. Radiologists should be aware of this complication to avoid diagnostic confusion in these patients.

Arteriovenous Malformations↗
PubMed1988

Distal esophageal ballooning following Heller myotomy.

Eccentric ballooning of the distal esophagus was observed radiographically in 11 of 23 patients (48%) who underwent Heller myotomy for achalasia. While, to the authors' knowledge, ballooning at the site of myotomy incision has not been described previously in the radiologic literature, it should be recognized as a normal and frequent postoperative finding. Radiologists should be aware of this finding so that it is not mistaken for postoperative abnormalities following esophagomyotomy or an epiphrenic diverticulum.

Adult↗
PubMed1988

Herpes esophagitis: sensitivity of double-contrast esophagography.

During a 10-year period between 1978 and 1987, there were 25 confirmed cases of herpes esophagitis with positive esophageal brushings, biopsies, and/or cultures for the herpes simplex virus. Eighteen of those patients had double-contrast esophagrams, but two were excluded from our study because they had combined fungal and viral esophagitis. All of the remaining 16 patients were symptomatic, and 14 were immunocompromised. Herpes esophagitis was diagnosed on the original radiographic reports in nine (56%) of those 16 patients. In all nine, double-contrast radiographs revealed discrete, superficial ulcers on a relatively normal background mucosa without significant plaque formation. In the remaining seven patients, double-contrast esophagrams revealed plaquelike lesions that were indistinguishable from those of Candida esophagitis (four cases), thickened folds (two cases), and a giant esophageal ulcer (one case). During the same period, herpes esophagitis was diagnosed on seven other double-contrast esophagrams in which histologic, cytologic, and virologic studies were negative for the herpes simplex virus. However, the endoscopic findings were also suspicious for herpes esophagitis in six of those cases, suggesting that they may represent true-positive cases in which there was inadequate tissue sampling. Thus, our experience indicates that radiographic abnormalities can almost always be detected on double-contrast esophagrams in patients with herpes esophagitis, and in more than 50% of cases, a specific radiographic diagnosis can be made because of discrete ulcers without significant plaque formation.

Adult↗
PubMed1988

The tailored double-contrast pharyngogram.

When high-density barium coats the intrinsically smooth squamous mucosa of the pharynx, many nodules are seen at the base of the tongue and valleculae and many longitudinally oriented lines are seen in the lateral and posterior pharyngeal walls. This normal radiographic appearance reflects the lymphoid tissue and longitudinal muscle layer which intimately underlie the squamous mucosa. This paper discusses the gross and microscopic anatomy pertinent to interpretation of double-contrast films of the pharynx. The techniques for achieving a high-quality double-contrast examination of the pharynx are presented.

Barium Sulfate↗
PubMed1987

Granular small bowel mucosa: a reflection of villous abnormality.

Diffuse mucosal granularity was reported recently in small bowel Crohn's disease. The radiographic appearance corresponded on histopathologic examination to villous hypertrophy, fusion, or epithelial bridge formation. We have observed similar granularity in Crohn's disease but also in several other conditions, including radiation enteritis, pancreatic glucagonoma, protein-losing enteropathy, and small bowel ischemia. Histopathologic examination demonstrated various alterations in villous morphology, such as edema, hyperplasia, clubbing, or fusion. In Crohn's disease, this appearance was sometimes an indication of early inflammatory disease but was also seen following extensive small bowel resection, possibly due to villous enlargement resulting from intestinal adaptation. These findings suggest that granular mucosa in the small bowel is a nonspecific finding reflecting an alteration in villous structure.

Adult↗