Biomedical subjects
Publications and source records attributed to V A Rowley.
We report a case of ureterocolic fistula secondary to urolithiasis in a 70-year-old female imaged with both CT and an antegrade nephrostogram. The ureterocolic fistula was managed with insertion of an antegrade ureteral stent.
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Explore the source record for details and available documents.
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Abdominal radiographs are commonly requested indiscriminately for patients with abdominal pain, but the results of many such examinations are negative or non-specific. In today's era of high-technology studies, such as ultrasonography, computed tomography and magnetic resonance imaging, plain abdominal radiography is still appropriate in some situations, and the interpretation of abdominal plain films remains an essential and challenging component of most radiology practices. This article reviews a number of issues regarding the use of plain radiography: the common causes of abdominal pain in patients presenting to a typical emergency department; the appropriate indications for this type of examination so that the number of unnecessary examinations is minimized and the diagnostic yield thereby maximized; and the appropriate views to be obtained, the rationale for their use and a proposed format for standardized viewing of abdominal plain films. The article concludes with a practical review of some commonly misunderstood points regarding the bowel gas pattern and ascites.
Needle track seeding is a rare complication of percutaneous needle biopsy which has become less frequent with the advent of the fine needle. We describe one case of malignant cutaneous seeding following fine needle aspiration of a peripherally based hepatic metastasis from colonic carcinoma. This report underlines the need to traverse normal adjacent liver parenchyma prior to entering a peripherally-based metastatic deposit to reduce the likelihood of malignant cutaneous seeding.
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Surgical cholecystostomy is performed often at our institution for emergent management of acute calculous cholecystitis in high-risk elderly patients. Gallstones are removed either during surgery or by subsequent radiologic manipulation. Most such patients do not undergo subsequent cholecystectomy. The frequency of gallbladder stone and/or biliary symptom recurrence was studied in 63 patients who had undergone successful cholecystolithotomy. Follow-up examinations in 48 of these patients, performed at a mean of 18 +/- 12 months after surgery, showed recurrence of gallstones in 13 patients (27%). This included 12 of 38 patients who had follow-up sonograms and one of two cadavers that underwent autopsy. None of eight patients who had a subsequent cholecystectomy had recurrent stones. Two of 17 patients studied within 1 year of cholecystolithotomy had recurrent calculi, as did six of 21 patients studied at 1-2 years, four of five patients studied at 2-3 years, and one of five patients studied at 3-4 years. Biliary symptoms were assessed in 46 of the 48 patients who had follow-up examinations (two patients died) and in the 15 other patients who had undergone successful cholecystolithotomy. Recurrent or residual symptoms were present in seven (11%) of 61 patients, including three of the 13 patients with recurrent calculi. Six of these seven patients underwent further hospital treatment. These results confirm the anticipated high frequency of stone recurrence after cholecystolithotomy. However, because most patients with recurrent stones were asymptomatic, routine interval cholecystectomy may not be necessary.
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Nine patients with cholelithiasis were selected for adjuvant therapy with extracorporeal shock-wave lithotripsy when radiologic or endoscopic intervention alone had been unsuccessful for stone removal. This preliminary experience with shock-wave lithotripsy includes four patients with one or more common duct stones, one patient with a large solitary gallbladder stone, and four patients with impacted cystic duct stones. Lithotripsy failed in two patients with cystic duct stones. The seven patients with successful lithotripsy underwent subsequent fragment extraction by intervention via T-tube tract, minicholecystostomy, or endoscopic sphincterotomy. Our approach to cholelithotripsy varied from previous reports in that we included patients with cystic duct stones, relied on interventional fragment removal without adjuvant chemolitholysis, and treated four patients with acute symptoms or multiple risk factors. Our initial experience with biliary lithotripsy in selected patients indicates that it can play an integral part in nonsurgical intervention for cholelithiasis.
In order to determine if serial, noninvasive evaluation of polytetrafluoroethylene (PTFE) vascular access grafts could identify a subgroup of patients at risk for thrombosis, the authors studied flow characteristics, using duplex ultrasonic scanning, in 18 hemodialysis patients with forearm loop grafts. On average, five examinations were performed per patient over the 10-month study period. Seven episodes of thrombosis occurred in six patients. The mean Doppler flow in grafts that subsequently thrombosed was significantly lower than in those that did not (544 +/- 218 ml/min versus 843 +/- 391 ml/min, p less than 0.001). The interval from last examination to thrombosis ranged from 13 to 58 days. At a defined cut-off flow of 450 ml/min, this test yielded a sensitivity of 83% and a specificity of 75% for episodes of thrombosis occurring within 2 to 6 weeks. The authors conclude that episodes of thrombosis in PTFE arm loop grafts are usually preceded by significantly lower Doppler-measured flow than grafts that do not thrombose and that it may be possible, by this means, to identify grafts at risk.
Using a real-time mechanical sector scanner in a transverse plane of section, the authors noticed that a double image of an intrauterine gestational sac or an intrauterine contraceptive device can be obtained when the transducer is passed over the midline of the abdomen. It was suggested that this is caused by refraction of the sound passing through the medial edges of both rectus abdominis muscles. The authors were able to reproduce this artifact in vitro using isolated human cadaver rectus muscles and imaging a single object in a water bath.
Patients suffering from five primary and three secondary, large, non-uterine, abdominal leiomyosarcomas were examined by ultrasound. Seven demonstrated a mass with an echogenic rim of varying thickness surrounding a central cystic component, while one showed a variation of this pattern. Pathological description of the cystic component contents, available in six examples, correlated well with the sonographic findings. Due to the relative frequency with which large leiomyosarcomas present in this fashion, a pre-biopsy diagnosis should be possible in the majority.
Lobar dysmorphism is one of a number of normal anatomic variants that may simulate renal mass lesions on cross-sectional imaging. The authors report the US and CT features in two patients with this unusual entity.