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T J Imray

Publications and source records attributed to T J Imray.

At least 19 recordsLinked to original sources
PubMed1999

Large degenerated adrenal adenomas: radiologic-pathologic correlation.

PURPOSE: To correlate the radiologic and pathologic findings and differential diagnosis of large, degenerated adrenal adenomas. MATERIALS AND METHODS: The authors reviewed the radiologic and pathologic characteristics of 30 large adenomas with cystic regions or areas of heterogeneity that were either intrinsic or demonstrated at contrast material-enhanced computed tomography (CT) or magnetic resonance (MR) imaging. Images of 24 adrenocortical carcinomas were also reviewed to determine whether differentiating characteristics existed. RESULTS: Most of the adrenocortical adenomas were in asymptomatic women. Ten adenomas contained calcification. Pathologic examination revealed good correlation between heterogeneity and liquefied regions. Histologic examination confirmed regions of adenomatous tissue with areas of hemorrhage, amorphous degenerated material, calcification, and fibrosis. Some tumors contained myelolipomatous foci. Although some clinical and imaging findings differed between the groups, no features could be found that enabled the radiologic differentiation of adenomas from carcinomas. CONCLUSION: A subgroup of adrenal adenomas are larger, more heterogeneous, and more frequently calcified than those with the usual imaging findings. Central necrosis, hemorrhage, or both are responsible for many of the imaging features. Differentiation of these lesions from other large adrenal masses, including adrenal carcinoma, cannot be made by means of imaging alone; resection is required for the definitive diagnosis.

Adrenal Cortex↗
PubMed1990

Bilateral fibroepithelial polyps of ureter in a child.

Presented here is the first case of bilateral ureteral polyps in a patient under eighteen years of age, with vivid colored intraoperative photographs. The importance of careful identification of the base of the polyp to reduce operative morbidity and the necessity of ureteral reanastomosis rather than simple excision of the polyp in children is emphasized.

Anastomosis, Surgical↗
PubMed1988

Assessment of cardiac size on portable chest films.

Using both anthropomorphic phantoms and human patients, the authors have shown that the effects on cardiothoracic (CT) ratio of changing from the posteroanterior (PA) to the anteroposterior (AP) projection are much greater than the effect of reducing the anode-to-film distance (AFD). This is because, in the AP projection, not only is the transverse diameter (TD) of the heart much farther from the film (and its image is therefore enlarged), but the TD of the chest is usually closer to the film and its image is reduced in size. These factors, operating in different directions, cause a major change in the CT ratio. The authors have shown that small hearts are magnified more than large hearts by changing from PA to AP, and that the position of the TD of the thorax (whether it is farther anterior or farther posterior) markedly affects what happens to the CT ratio when the AFD is changed. Because of this, it is impossible to predict accurately what effects a given AFD and projection will have on the CT ratio. However, using approximate correction factors (-12.5% of CT ratio for a 40 in AFD, AP film and -10% of CT ratio for a 72 in AFD, AP film) a clinically useful determination can be rapidly made as to whether the heart is enlarged or not.

Cardiomegaly↗
PubMed1988

Artifacts and diagnostic pitfalls on magnetic resonance imaging: a clinical review.

High field MRI of the brain occasionally exhibits imaging artifacts; most artifacts are obvious and easily recognized, but some are subtle and mimic disease. A thorough understanding of brain MRI artifacts is important to avoid potential diagnostic pitfalls. Some imaging techniques or procedures could be utilized to remove or identify artifacts. These include additional projections, different pulse sequence, and 90 degree shift of phase-encoding gradient. The use of respiratory gating or cardiac gating may also improve image quality by reducing some of the motion-related artifacts.

Adolescent↗
PubMed1987

Importance of prone-position film during intravenous urography in detection of bladder tumors.

Three patients with neoplasms on the anterior wall or dome of the urinary bladder underwent intravenous urography (IVU). In each case, the lesion was detected only on the prone-position radiograph. Contrast medium layers in the dependent part of the bladder. If all filming is performed with the patient in supine position, lesions on the anterior wall may be undetected. We advocate routine inclusion of one prone-position film during IVU.

Adenocarcinoma↗
PubMed1985

Osteogenic and sarcomatoid differentiation of a renal cell carcinoma.

Sarcomatoid renal cell carcinoma is an uncommon renal tumor, and osteogenic differentiation has been reported in only a few of these tumors. The authors report such a case with radiographic, light microscopic, and electron microscopic findings, which demonstrate that the sarcomatoid areas of the tumor are derived from the malignant epithelial cells, retaining epithelial features such as desmosomes and lumina with microvilli. The use of electron microscopy is important in the establishment of this diagnosis.

Aged↗
PubMed1984

Renal arteriovenous fistula associated with fibromuscular dysplasia.

A case is reported of a woman with long-standing progressive hypertension and an abdominal bruit who on angiography demonstrated fibromuscular dysplasia of the right renal artery and an arteriovenous fistula in the upper pole of the right kidney. The various causes of renal arteriovenous fistula are reviewed. The relationship of mural aneurysms seen in fibromuscular dysplasia and the formation of arteriovenous fistulas by rupture of these aneurysms is discussed. Review of the English literature indicates a probable causal relationship between fibromuscular dysplasia of the renal arteries and intrarenal arteriovenous fistulas.

Arterial Occlusive Diseases↗
PubMed1984

The vascular pedicle and the vena azygos. Part III: In trauma--the "vanishing" azygos.

The chest radiographs of 158 patients with widened vascular pedicles were examined. The vascular pedicle was measured and the presence or absence of the right paratracheal stripe and the vena azygos on the radiographs was noted. Increasing the systemic blood volume (or assuming the supine position) causes the vascular pedicle of the heart to widen predominantly to the right, and the vena azygos to enlarge simultaneously. In contrast, extravascular bleeding from aortic damage causes the pedicle to widen predominantly to the left of the midline; at the same time the paratracheal stripe and azygos "vanish." This combination of physiologic and pathologic, and intravascular and extravascular causes of widening of the pedicle. Extravasation of blood or saline from a traumatic right subclavian puncture can cause local bulging of the pedicle to the right and a vanishing azygos. Because the left side of the pedicle remains normal, this can be readily differentiated from an aortic tear.

Adult↗
PubMed1984

Pneumomediastinum: a diagnostic problem.

Pneumomediastinum has numerous etiologies and its pathways of spread are multiple and well defined. Knowledge of these anatomic pathways and possible etiologies is important in order to avoid extensive and unnecessary evaluations. For example, if there is a known reason for pneumomediastinum, and pneumoperitoneum is present without associated abdominal findings, further evaluation for perforated viscus is unnecessary. In a patient who is an asthmatic or a diabetic, the presence of pneumomediastinum should not lead to work-up with contrast studies unless there are specific clinical reasons to do so. In critically ill infants and adults, pulmonary interstitial emphysema is an important warning sign for impending pneumothorax or pneumomediastinum and the patient's physicians should be alerted. There are occasional difficulties in differentiating pneumomediastinum from pneumopericardium and from a medial pneumothorax. Analysis of anatomic details and decubitus views are helpful in this regard.

Adult↗
PubMed1982

Radiographic identification of loose bodies in the traumatized hip joint.

Acrylic spacers and cubes of cortical bone of known dimensions were placed in predetermined locations in cadaver hip joints, which were then studied with plain radiography and linear, hypocycloidal, and computed tomography (CT). Joint space widening was not measurable on plain radiographs of the pelvis when 2-mm spacers were placed anywhere within the hip joint. When 4-mm spacers were used, widening measured 2 mm in the axis of measurement corresponding to the location of the spacer. Linear tomography did not permit identification of the 2-mm cubes; however, hypocycloidal tomography and CT consistently showed them anywhere within the hip joint. Radiation dose and clinical recommendations are discussed.

Cadaver↗
PubMed1981

Method for detecting a progressive renal disorder superimposed on a preexisting progressive renal disorder.

We describe a patient with declining renal function due to polycystic kidney disease, who then insidiously develops bilateral renal artery stenosis. The major clue which led to the discovery of the bilateral renal artery stenosis was the finding of an unexpected increase in the rate of loss of renal function. This assessment was based on analysis of the slope of a plot of the reciprocal of the patient's serum creatinine concentration vs. time (reciprocal creatinine plot). The rationale for the use of the reciprocal creatinine plot to detect a progressive renal disorder superimposed upon a preexisting progressive renal disorder, is discussed.

Creatinine↗