Biomedical subjects
Publications and source records attributed to S N Weiner.
The Klippel-Trenaunay syndrome is composed of the triad of unilateral limb hypertrophy, abnormalities of the deep venous system, and port-wine hemangiomas. An interesting case is presented in which there were multiple abnormalities of the renal veins and intrarenal hemangiomas resulting in renal failure in addition to the usual peripheral abnormalities.
Hemodialysis is essential in the management of end stage renal disease patients. Forty-eight contrast examinations of hemodialysis vascular access devices were reviewed. Venous fistulography is the method of choice for the evaluation of these devices. Only 12 patients in this series required arteriography and 6 of them had a lower extremity access device. The most common complications included venous stenoses, venous or graft aneurysms, pseudoaneurysms and venous or graft thrombosis. Pseudointimal proliferation resulting in graft stenosis was also observed.
The computed tomographic demonstration of a mediastinal pseudocyst communicating with the pancreatic duct in a patient with severe acute pancreatitis is reported. An awareness of this communication was essential in planning the appropriate surgical management.
The computed tomographic and sonographic findings of 26 patients with gallbladder carcinoma were reviewed, and the problems and pitfalls encountered with these imaging techniques are discussed. The most common finding, a mass filling or replacing the gallbladder, was seen in 42% of the patients. A mass protruding into the gallbladder was seen in 23%, and diffuse asymmetric thickening of the gallbladder wall in 15%. Recommendations are made to avoid some of the diagnostic problems encountered. With careful and meticulous technique early carcinoma of the gallbladder may be detected with greater frequency by cross-sectional imaging techniques.
The evaluation and management of patients with severe persistent urinary tract infection after appropriate antibiotic therapy can be difficult. The first radiologic examination is usually excretory urography, but the findings often are nonspecific. A group of 40 patients was studied to assess the contribution of cross-sectional imaging and included patients with diffuse and focal pyelonephritis, renal abscess, pyonephrosis, and pararenal abscess. Indications for cross-sectional imaging include persistent symptoms despite antibiotics, predisposing "risk factors," suspicion of flank mass on other imaging methods, and no excretion on urography. Percutaneous aspiration and/or drainage for diagnosis and/or treatment can be guided by the cross-sectional imaging methods.
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The nutcracker syndrome refers to compression of the left renal vein between the aorta and superior mesenteric artery which results in renal vein and left gonadal vein varices. This is an unusual but well accepted cause of hematuria. We report a case of the nutcracker syndrome and present the radiologic workup including computerized tomography (CT) and renal venography with venous pressure measurements.
Two cases of pheochromocytoma that invaded the inferior vena cava are reported. The significance of this finding in regard to the malignant potential of the tumor and the role of sonography in the evaluation of intracaval tumor are discussed.
Although popliteal artery aneurysms are among the most common type of peripheral artery aneurysm, they may be difficult to diagnose until complications such as peripheral embolization, acute thrombosis and rupture occur. Pressure on adjacent structures may cause neurological symptoms and venous thrombosis. The diagnosis of peripheral artery aneurysms is usually made by physical examination and arteriography. Recently, ultrasound of the popliteal space has been found to be very useful in the diagnosis of popliteal artery aneurysms. It is therefore important to recognize the value of ultrasound for imaging popliteal artery aneurysms and to use this readily available non-invasive modality in patients in which physical examination and/or angiography of the popliteal fossa is equivocal. We present one case of a popliteal artery aneurysm which was missed by angiography and physical examination in which ultrasound was very important in diagnosing this aneurysm pre-operatively, and two cases in which the ultrasound examination confirmed the presence of the popliteal artery aneurysm but better delineated its size than did angiography.
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A case of both adrenal myelolipoma and adenoma is presented. The diagnosis of myelolipoma was suggested preoperatively by computed tomography in which one of the masses had negative attenuation coefficients.
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Two cases of renal oncocytoma (proximal tubular adenoma) with a similar angiographic appearance are reported. The vascular supply to the lesion tends to be arranged in "spoke-wheel" pattern with vessels radiating toward the center of the lesion; the angiographic appearance may help to differentiate renal oncocytoma from hypernephroma preoperatively.
A patient undergoing chronic corticosteroid therapy presented with mesenteric lipomatosis that simulated malignant masses. Computerized tomography was instrumental in identifying these apparent tumors as benign fatty deposits. The spectrum of lipomatous abdominal lesions amenable to diagnosis by computerized tomography is reviewed.