Biomedical subjects
Publications and source records attributed to T B Burt.
Inward buckling of the dura at C1-2 may occasionally occur with hyperextension of the neck and can result in a difficult or unsuccessful puncture when the posterior lateral C1-2 approach is used for cervical myelography. In this circumstance, placement of the head in a neutral or slightly flexed position may widen the posterior subarachnoid space and facilitate the needle puncture.
Patients with successfully treated Hodgkin disease are at increased risk for the development of second malignancies. We present two cases of intracranial non-Hodgkin lymphoma that appeared following successful treatment of Hodgkin disease. The appearance of the lymphomas on computed tomographic images is shown, and possible predisposing factors, differential diagnosis, and clinical implications are discussed.
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Pancreatic masses are uncommon lesions in the newborn infant. The authors present the first reported case of neonatal pancreatic hamartoma and describe its interesting clinical, histologic, and radiographic aspects.
The clinical data and radiographs of 50 neonates with pneumopericardium (PPC) were reviewed. Most of these neonates were premature, low-birth-weight infants with hyaline membrane disease who required ventilatory assistance. The presence of other extraventilatory air prior to (or concurrent with) PPC, the use of cardiopulmonary resuscitation with intracardiac drug administration, and improper endotracheal tube placement were contributory factors. However, it was not possible to determine why some infants progressed to PPC and others, with similar disease and predisposing conditions, did not. The primary radiographic sign of PPC is the "halo" sign, which was apparent in 96% of these cases. When this sign was not present, other signs, such as the "pericardial line" sign, were helpful. The overall mortality was 72%. Thirty-three per cent of the fatalities were related to PPC; however, the long-term prognosis is probably more closely related to the severity of underlying lung disease or other complications than to PPC.
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Blunt traumatic injury of the extrahepatic bile ducts (EBD) is uncommon. Familiarity with the wide spectrum of possible EBD injuries is essential, however, because of the increasing number of nonpenetrating abdominal injuries seen in modern society. These injuries include contusion with edema, hematoma and varying degrees of laceration. Edema and hematoma can result in transient bile duct obstruction that clears spontaneously or cicatrizing inflammatory reaction resulting in stricture and obstruction. Common bile duct stricture following blunt trauma is extremely rare, but is an unfortunate late complication requiring biliary decompression to relieve progressive jaundice. Laceration (partial or complete) can occur at any location in the EBD and can be life-threatening if the diagnosis is overlooked. Hemobilia is an unusual complication of laceration of the EBD. Failure to recognize the clinical manifestations of these uncommon injuries results in delayed and often incorrect diagnoses. Percutaneous transhepatic cholangiography is a safe and accurate procedure that is an important step in the workup of jaundice following blunt trauma.
Although synovial cysts are most commonly associated with rheumatoid arthritis and osteoarthritis, they may occur in many other conditions. The clinical manifestations of these cysts are numerous and may result from pressure, dissection or acute rupture. Vascular phenomena occur when popliteal cysts compress vessels, and result in venous stasis with subsequent lower extremity edema or thrombophlebitis. Rarely, popliteal cysts may cause arterial compromise with intermittent claudication. Neurological sequelae include pain, paresthesia, sensory loss, and muscle weakness or atrophy. When synovial cysts occur as mass lesions they may mimic popliteal aneurysms or hematomas, adenopathy, tumors or even inguinal hernias. Cutaneous joint fistulas, septic arthritis or osteomyelitis, and spinal cord and bladder compression are examples of other infrequent complications. Awareness of the heterogeneous manifestations of synovial cysts may enable clinicians to avoid unnecessary diagnostic studies and delay in appropriate management. Arthrography remains the definitive diagnostic procedure of choice, although ultrasound testing may be useful.
Gas has a characteristic ultrasound pattern, usually recognized as an area of focal dense echogenicity with acoustic shadowing. It often contains reverberation echoes. Sonographers should be familiar with this pattern and should suspect underlying disease when gas is demonstrated in abnormal or unusual locations. The authors have collected 18 cases; four representative cases are presented to illustrate this principle.
Evaluation of the postoperative lumbar spine is sometimes difficult because of obliteration of epidural fat by hypertrophic scarring. We examined 70 patients using a high-dose intravenous contrast technique in an attempt to distinguish hypertrophic scarring from herniated disk. The CT interpretation was confirmed in all 17 patients who had follow-up operations. Thirteen had herniated disk material associated with scar and four had hypertrophic scarring only. The latter four patients underwent reoperation because of concomitant foraminal or spinal canal stenosis seen on CT. Twelve of the herniated disks had the expected appearance of a nonenhancing mass surrounded by a rim of enhancing scar tissue. In the 13th patient, homogeneous enhancement of the herniated disk was seen. It is thought that chronically herniated disks, such as this one, may incite enough surrounding scar to give the CT appearance of an enhancing disk. Finally, marginal enhancement in the anulus fibrosus region was seen in over 90% of disk spaces examined. Although an anatomical explanation cannot be given at present, this phenomenon is thought to represent a normal finding.
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CSF motion from transmitted vascular pulsations can result in focal areas of CSF hypointensity on MR images because of signal mismapping from phase shift. When this CSF flow void occurs adjacent to the basilar artery in the prepontine cistern, it may be mistaken for a basilar artery aneurysm on proton-density and T2-weighted spin-echo images. Head MR scans of 50 consecutive patients referred for various indications were reviewed, and this phenomenon was noted in the prepontine cistern in 38 patients. Fifteen of these images had an appearance mimicking an aneurysm. When doubt exists, dynamic high-resolution CT scans should be sufficient for clarification.
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