Renal arteriovenous fistula in the setting of subacute bacterial endocarditis.
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Biomedical subjects
Publications and source records attributed to T F Stephenson.
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The ability of excretory urography and computerized tomography to detect renal masses was compared in 120 consecutive cases. Computerized tomography consistently provided more information than excretory urography, usually was able to distinguish renal tumors from cysts and provided additional useful information regarding staging of renal neoplasms and the presence of unsuspected associated pathological conditions.
Because of a potential film cost savings of approximately 35% using photographic print paper instead of X-ray film in recording CT images, a comparison was undertaken of these hard copy recording methods. One hundred consecutive CT examinations were reviewed on the scanner display console and recorded on X-ray film and photographic print paper using a multi-imager camera. Hard copy images were compared for diagnostic adequacy. X-ray film adequately recorded the pathology in all cases. Photographic paper adequately recorded the pathology in 97% of cases. In 26% of cases X-ray film was felt to better display the CT diagnosis whereas in 2% of cases photographic paper better displayed the CT diagnosis. Test phantom scans recorded on both media showed no observable difference in spatial or contrast resolution.
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A defect in the renal margin secondary to extrahilar entry of renal vessels was detected at urography in three patients. Extrahilar entry of renal vessels is not uncommon and is well known to anastomists and surgeons. It has not been previously reported as a radiographic finding. In the past these marginal defects may have been assumed to be persistent fetal lobulation or scarring from previous renal infarction or pyelonephritis. Arteriography may be necessary to distinguish between these possibilities and occasionally to exclude a renal tumor or cyst.
Precision percutaneous needle aspiration biopsy under guidance of computed tomography is facilitated by injection of a small amount of contrast material during the biopsy procedure. CT scan immediately after biopsy clearly documents the biopsy site. There was no adverse effect of the contrast agents on the quality of staining or preservation of cellular architecture. To the contrary, the aspirates obtained after contrast injection were generally better preserved and better stained than the control specimens. This may be due to a decrease in drying, with the more fluid aspirates obtained after contrast injection.
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The authors describe a case of unilateral renal artery occlusion in which a thin, dense rim was seen on infusion pyelography with subsequent marked atrophy of the kidney. This "cortical rim sign" appears to be due to collateral blood supply from the renal capsule, preserving a thin rim of viable cortex.
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Biplane digital subtraction angiography was utilized in 200 patients having intravenous or intra arterial studies. Images were of excellent quality without cross fogging by scattered radiation using an alternating exposure series. Decreased contrast load and decreased procedure time were significant benefits.
Biplane DSA, particularly with the option of non-isocentric positioning of the two imaging chains, further decreases the risk of angiography by obtaining multiple views of the same area or views of two different anatomic areas during a single injection of contrast material. For example, an aortorenal angiogram can be recorded at the same time as an arch aortogram using a single injection of contrast. Similarly an intracranial view can be recorded with the same contrast injection as an arch aortogram or cervical carotid arteriogram.
Intracranial dermoid tumors have characteristic MR and CT appearances. Rupture of an intracranial dermoid produces a dramatic MR and CT appearance. Two cases of ruptured intracranial dermoid tumors are presented, one with rupture into the subarachnoid space, another with rupture into the ventricles. MR and CT findings are included.
Metrizamide is largely replacing iophendylate (Pantopaque) for routine lumbar myelography. Better visualization of the nerve root sheaths should make metrizamide myelography more sensitive in detecting laterally herniated disks, such that epidural venography might be required less often. However, that expectation has not been realized. In over 800 consecutive myelograms, one-half obtained with iophendylate and one-half obtained with metrizamide, 60 patients still required epidural venography. Nearly as many had metrizamide as had iophendylate (28 versus 32). Further, the number of positive epidural venograms with herniated disks confirmed at surgery was not significantly different (12 versus 11). Epidural venography is still indicated after negative or equivocal metrizamide myelography if strong clinical suspicion of herniated disk persists.