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PubMedDate not supplied

Pulmonary arteriopexy to relieve tracheobronchial compression by dilated pulmonary arteries.

Adequate treatment of pulmonary artery compression of the tracheobronchial tree requires a high index of suspicion for the diagnosis, precise localization of the sites of airway compromise by bronchoscopy, and accurate identification of the anatomy of the obstructing vascular structures. Surgical correction of this vascular anomaly to relieve airway compression is necessary in many infants and should be performed promptly. Pulmonary artery plication, arteriopexy, or aneurysmorrhaphy is well tolerated and can be dramatically successful in improving airway patency.

Bronchial Diseases↗

PubMed1984

Infundibulopelvic stenosis in children.

Of 11,500 children who underwent excretory urography during a 17-year period, three were found to have the rare renal malformation infundibulopelvic stenosis, characterized by caliceal dilatation, infundibular stenosis, and hypoplasia or stenosis of the renal pelvis. The contralateral kidney was absent in two cases and normal in the other. Voiding cystourethrograms were normal in all three. Renal sonography showed a variable degree of caliceal dilatation without associated pelvic dilatation. The diagnosis was confirmed by retrograde ureteropyelography in one case. Two patients were followed for 12 and 18 months, respectively; both remained asymptomatic with normal renal function, and sequential sonographic examinations of their kidneys have shown no significant changes. The third patient died of an unrelated condition. Infundibulopelvic stenosis has highly characteristic radiographic features, and prognosis is good for most affected patients.

Child↗

PubMed2003

Secretin-stimulated magnetic resonance pancreaticogram to assess pancreatic duct outflow obstruction in evaluation of idiopathic acute recurrent pancreatitis: a pilot study.

Magnetic resonance pancreatography is a new modality to visualize the pancreatic duct. Prolonged dilation of the pancreatic duct following secretin administration may suggest obstruction at the level of the pancreatic duct orifice. We describe 10 patients with idiopathic acute recurrent pancreatitis who underwent secretin-stimulated magnetic resonance pancreatography with subsequent endoscopic retrograde pancreatogram with or without manometry. All patients had complete visualization of the main pancreatic duct and no evidence of chronic duct disease. Two patients had pancreas divisum. Three had prolonged dilation of the pancreatic duct on secretin-stimulated magnetic resonance pancreatography and evidence of pancreatic duct outflow obstruction. Four additional patients with pancreatic duct outflow obstruction had normal secretin-stimulated magnetic resonance pancreatography. In conclusion, secretin stimulated magnetic resonance pancreatography provides high quality pancreatic duct images and has high specificity but low sensitivity for diagnosing pancreatic duct outflow obstruction using manometric/clinical criteria.

Acute Disease↗

PubMed1985

Bronchial compression by dilated pulmonary artery. Surgical treatment.

Bronchial compression by a dilated left pulmonary artery complicated the postoperative course in two infants: one after a Mustard operation for transposition of the great arteries, restrictive ventricular septal defect, and moderate pulmonary stenosis, the second after correction of tetralogy of Fallot with absent pulmonary valve. In both cases the bronchial compression was successfully treated by division of the left pulmonary artery and its prolongation by interposition of a conduit.

Bronchial Diseases↗

PubMed1980

[Choledochotomy and the methods for its performance].

The authors have made 390 operations on ductus choledochus. Indications for choledochotomy were choledocholithiasis, jaundice, cholangitis and others. The ideal choledochotomy was fulfilled in 7,1% of cases as a completion of diagnostic manipulations on the duct. The external drainage of ductus choledochus was performed in peritonitis, severe cholangitis and inflammatory alterations of the hepatoduodenal ligament and in weak senile patients (mortality--11,7%). Multiple stones and great dilatation of the duct (mortality--4,5%) were considered to serve indications for supraduodenal choledochoduodenostomy (38,7%). Papillotomy was made in fixed ampula stones, stenosis of Vater's papilla (18,2%). Lethality in such cases was twice as high as after choledochoduodenostomy (8,5%). The authors believe peritonitis and duodenostasis to be contraindications against the internal drainage of biliary ducts.

Ampulla of Vater↗

PubMed1993

Nonobstructive dilatation of upper urinary tract may later convert to obstruction.

We report on 5 babies found to have pyelocaliectasis or hydroureteronephrosis antenatally who were evaluated soon after birth because of persistent mild or moderate upper urinary tract dilatation. In each instance, vesicoureteral reflux was absent and the technetium-99m diethylenetriaminepentaacetic acid renal scan revealed good function in the ipsilateral kidney. Renogram curves, after furosemide, did not show an obstructed pattern. Indeed, allowing for the dilatation, the drainage patterns were thought to be normal. In each instance the patient represented or was found on follow-up to have increased dilatation. Renograms were then repeated, using the same radiopharmaceutical and dose of diuretic. An obstructive pattern was seen in each instance. These significant observations demonstrate that nonobstructive hydronephrosis, diagnosed prenatally, may later convert to obstruction at the ureteropelvic junction (UPJ) or in the juxtavesical ureter (UVJ). Thus, careful follow-up, for a period yet to be determined, is desirable in patients in whom the initial postnatal evaluation does not demonstrate obstruction by current criteria.

Constriction, Pathologic↗

PubMed2003

[A case of unilateral giant hydronephrosis with contralateral dwarf kidney].

A 54-year-old woman was admitted to our hospital for oliguria and left lower abdominal pain. She had renal dysfunction with a serum creatinine of 9.1 mg/dl and blood urea nitrogen of 96.5 mg/dl. Plain computed tomography and magnetic resonance imaging revealed right dwarf kidney and left giant hydronephrosis with extravasation of urine. MR-urography revealed left dilated ureter caused by ureterovesical junction (UVJ) stenosis. Therefore, percutaneous nephrostomy was immediately performed to treat postrenal failure, with resulting collection of approximately 1,650 ml of urine. Subsequently, left ureterocystoneostomy was performed for the treatment of UVJ stenosis because improvement of left UVJ stenosis had not been confirmed by nephrostography during follow-up. Judging from the past history of myoma operated and reactive fibrosis of stump of left ureter histopathologically, it was considered that acquired UVJ stenosis had led to giant hydronephrosis.

Constriction, Pathologic↗

PubMed2000

Pancreaticobiliary ductal system: value of half-Fourier rapid acquisition with relaxation enhancement MR cholangiopancreatography for postoperative evaluation.

PURPOSE: To assess the usefulness of half-Fourier rapid acquisition with relaxation enhancement (RARE) magnetic resonance cholangiopancreatography (MRCP) for evaluation of postoperative changes in the pancreaticobiliary ductal system. MATERIALS AND METHODS: The study included 34 patients (20 men, 14 women; mean age, 65.5 years) who underwent surgery of the pancreaticobiliary ductal system. Half-Fourier RARE MRCP images were obtained after surgery. Qualitative evaluation included ratings by two observers for depiction of postoperative anatomy and for artifacts, as well as analysis of postoperative complications. Direct cholangiographic, computed tomographic, and ultrasonographic findings and 6-month follow-up results were the reference standard. Sensitivity, specificity, and accuracy were calculated for the evaluation of postsurgical complications seen at half-Fourier RARE MRCP. RESULTS: The sensitivity, specificity, and accuracy of MRCP for the evaluation of postsurgical complications were each 100% for ductal dilatation; 100%, 87%, and 89%, respectively, for choledochoenteric anastomotic stricture; 100%, 86%, and 87%, respectively, for pancreaticoenteric anastomotic stricture; 100% each for intraductal stones and anastomotic leakage; and 80%, 100%, and 94%, respectively, for cholangitis. CONCLUSION: Half-Fourier RARE MRCP is a reliable imaging technique for the evaluation of anatomy and of complications associated with a surgically altered pancreaticobiliary ductal system.

Adult↗

PubMed2005

Abdominal CT findings may suggest coeliac disease.

BACKGROUND: Coeliac disease is the most common gastrointestinal immunological disorder in the western countries. Many adult patients present non-specific symptoms and signs of malabsorption such as chronic diarrhoea, anaemia, weight loss and abdominal distention. In non-specific and doubtful conditions, computed tomography is often the first medical examination performed. In a clinical practice, a critical review of computed tomography signs is therefore mandatory. AIMS: To evaluate the abdominal computed tomography findings, which are useful to suggest the presence of coeliac disease in adult patients. PATIENTS AND METHODS: The computed tomography studies of 28 coeliac patients were reviewed, looking for any intestinal and extraintestinal abnormality. The computed tomography findings evaluated were: abnormalities of intestinal fold pattern, bowel dilatation, fluid and air excess, duodenal abnormalities, intestinal intussusception, bowel wall thickening, lymphadenopathy, ascites, intestinal stenosis, mesenteric vascular changes. The abdominal computed tomography of a group of 30 normal subjects was also analysed. RESULTS: Intestinal fold pattern abnormalities were seen in 23/28 patients. Intestinal dilatation was seen in 21/28. Fluid excess in 18/28 and lymphadenopathy was seen in 12/28 patients; engorgement of mesenteric vessels in 7/28. Bowel wall thickening was observed in 6/28 patients and transient intussusception was observed in 6/28 patients. Increased air content within the bowel in 4/28 and ascites in 2/28 patients. Bowel dilatation together with fluid excess was observed in 18/28 patients. None of the above mentioned abnormalities abnormalities were seen in normal subjects. CONCLUSIONS: Data of the present study show that several abdominal computed tomography findings may be seen in coeliac adult patients; these findings should be taken into consideration with a high in level of suspicion by radiologists, to avoid diagnostic delay and unnecessary diagnostic and therapeutic procedures.

Adult↗

PubMedDate not supplied

Tracheobronchial compression in acyanotic congenital heart disease.

Children with acyanotic congenital heart disease frequently develop respiratory difficulties such as atelectasis, pneumonia, or infantile lobar emphysema. In some cases, the cause of the respiratory difficulty is compression of the tracheobronchial tree by hypertensive dilated pulmonary arteries, since this type of heart disease frequently demonstrates large left-to-right intracardiac shunts. Sites of predilection for compression include the left main bronchus, the left upper lobe bronchus, the junction of the right bronchus intermedius and right middle lobe bronchus, and the left side of the distal trachea. Cardiac anomalies which predispose to this type of compression include ventricular septal defect, patent ductus arteriosus, interruption of the aortic arch, and tetralogy of Fallot. Pulmonary arteriopexy may relieve the tracheobronchial compression.

Bronchial Diseases↗

PubMed1995

[Choledochoduodenostomy in the treatment of benign disease of the common bile duct: evaluation of long-term results].

The Authors report their experience in the treatment of 36 patients managed by side-to-side choledochoduodenostomy for common bile duct disease and followed for a period of five years. The main indication to surgery was a choledochal dilatation more than 1.5 cm. The surgical technique consisted in a single layer side-to-side choledochoduodenostomy with absorbable suture according to Roessner. There was no operative mortality and few post surgical complications (six patients, 15.78%) were registered; 25 patients (69.45%) were completely asymptomatic at five years, while in six cases (16.66%) significant symptoms were observed. In one case a biliary gastropathy with no metaplasia was documented.

Aged↗

PubMed1980

Anisocoria in inner ear lesions.

In experiments using rabbits, the pupil on the side of irritative inner ear lesion showed dilatation, and that on the side of paretic lesion showed constriction. In the clinical observation of patients with unilateral inner ear diseases (134 cases), anisocoria was recognized in 54.5%. In 68.5% of these, anisocoria was induced after applying a drop of neosynephrine. The size of the pupil on the healthy side was smaller in 65.8% than the pupil on the healthy side. Anisocoria in inner ear lesions is believed to be due to vestibulo-sympathetic imbalance through the superior cervical sympathetic ganglion.

Adolescent↗

PubMed1977

Endoscopic retrograde pancreatography: analysis of the normal pancreatogram, and changes which are associated with chronic pancreatitis and pancreatic cancer.

The dimensions of the normal pancreatogram were determined by studies in 30 adults without demonstrable pancreatic disease. The main pancreatic duct had a mean maximum diameter of 3.1 mm, 2.4 mm and 1.4 mm in the head, body and tail of the pancreas respectively; diameters at the upper limit of normal were 4 mm, 3 mm, and 2 mm in these three regions; Changes in the main pancreatic duct were categorized, and the relative frequency of these changes was determined in 45 patients with chronic pancreatitis and 14 patients with pancreatic cancer; Obstruction of the main duct was usually associated with cancer, whereas dilatation throughout the duct was only observed in chronic pancreatitis, Segmental stricture was common in both diseases, but analysis of the corresponding cholangiogram permitted differentiation in some patients. Gross distortion of the duct system occurred only in chronic pancreatitis, and was frequently associated with calcification which was seen on plain abdominal X-ray film. The main pancreatic duct showed no abnormalities in five patients (11%) with chronic pancreatitis, and one patient (7%) with cancer. Analysis of changes in the main pancreatic duct usually permitted differentiation of chronic pancreatitis from pancreatic cancer.

Adult↗

PubMed2000

Isolated dissection of the celiac artery--a case report.

Isolated arterial dissection, which occurs with the absence of aortic dissection, has been reported in carotid and renal arteries but rarely in visceral arteries. A case of isolated celiac artery dissection is reported here. A healthy 58-year-old man experienced sudden upper abdominal pain, which continued for several days. A body computed tomogram (CT) showed a multiple low-density wedge-shaped area in the spleen, which was diagnosed as splenic infarction, and an aneurysm with thrombus in the celiac artery. A selective angiogram showed dilatation of the celiac artery with wall irregularity, and proximal occlusion of the hepatic artery. The distal hepatic artery was fed by collateral arteries from the superior mesenteric artery. Splenic infarction was probably due to the embolism from the thrombus in the dissected celiac artery. The absence of other vascular lesions and causes or risks for the arterial dissection would suggest the occurrence of spontaneous dissection. The dissection of visceral arteries should be considered in diagnosing acute abdominal pain.

Abdominal Pain↗

PubMed1996

Magnetic resonance cholangiography: comparison with endoscopic retrograde cholangiopancreatography.

BACKGROUND & AIMS: Magnetic resonance cholangiography (MRC) is a noninvasive diagnostic modality capable of producing high-quality images of the biliary tree. The purpose of this study was to determine in a prospective, blinded fashion the sensitivity and specificity of three-dimensional fast spin-echo (3D FSE) MRC for the evaluation of biliary tract abnormalities. METHODS: Forty-six patients referred for elective direct cholangiography (45 endoscopic retrograde cholangiopancreatography and 1 percutaneous transhepatic cholangiography) were studied prospectively with 3D FSE MRC during a 1-year period. All images were interpreted blindly by two radiologists. The presence of dilatation, strictures, and intraductal abnormalities was recorded. Sensitivity and specificity of 3D FSE MRC were determined using findings on direct cholangiography as the gold standard. RESULTS: MRC images of diagnostic quality were obtained in 44 (95.7%) of the patients. Sensitivity for the detection of bile duct dilatation (n = 27), biliary strictures (n = 10), and intraductal abnormalities (n = 7) was 96.3%, 90%, and 100%, respectively. In addition, the MRC showed 16 of 17 patients with normal bile ducts (specificity, 94.1%). CONCLUSIONS: MRC has a very high sensitivity and specificity in the evaluation of the biliary tract. Based on these data, we believe that the efficacy of MRC using 3D FSE is sufficient to warrant its use in the routine diagnosis of biliary tract disease.

Adolescent↗

PubMed2002

Childhood infundibular stenosis.

Infundibular stenosis is a rare condition marked by dilation of one or more calices proximal to a stenotic infundibulum. Contrary to older reports, more recent information suggests that progressive renal dysfunction occurs in a significant number of these patients. We present a case of incidentally discovered infundibular stenosis. On the basis of the existing published reports, we make several recommendations. Close monitoring for a decline in renal function secondary to hyperfiltration injury is essential, and a worsening should prompt referral to a pediatric nephrologist. Progressive hydronephrosis should be corrected surgically, although proof of effect on the disease process is lacking in the evidence-based reports.

Child, Preschool↗

PubMed2004

Bilateral infundibulopelvic stenosis without renal insufficiency: is surgery necessary?

The following case describes the clinical course of a patient with bilateral infundibulopelvic stenosis from her initial presentation at age 2 through the age of 14 years. This condition is associated with hypoplasia of segments of the upper collecting system and is characterized by dilated calyces that drain through stenotic infundibulae. Our patient is unique in that, although her renal function has slowly deteriorated with time, she has a persistently non-obstructive pattern on dynamic imaging studies. Only a minority of patients reported in the literature with this condition progress to renal insufficiency or failure. Although some patients have undergone surgery for presumed obstruction, surgical intervention has no proven benefit. Patients are at risk for hyperfiltration injury and should be followed for the development of hypertension, proteinuria and renal insufficiency. Without evidence of obstruction, medical management remains the cornerstone of treatment.

Child, Preschool↗

PubMed1998

Takayasu arteritis: evaluation of the thoracic aorta with CT angiography.

PURPOSE: To determine the diagnostic accuracy of computed tomographic (CT) angiography in the evaluation of Takayasu arteritis. MATERIALS AND METHODS: Twenty-five patients with clinical symptoms suggestive of Takayasu arteritis underwent CT angiography and conventional angiography. Takayasu arteritis was diagnosed in 20 patients on the basis of conventional angiography. CT angiography was performed with a helical CT scanner after injection of a bolus of contrast material, and images were generated for three-dimensional display, multiplanar reformation, and maximum intensity projection. For vascular assessment, all images from CT angiography were used, and the results were compared with those from conventional angiography. RESULTS: CT angiography clearly depicted various luminal changes, including stenosis, occlusion, dilatation, and aneurysm, in the thoracic aorta and its major branches. CT angiography accurately depicted 190 (95%) of 200 arteries, although the extent of the steno-occlusive lesions was overestimated in five (2%) and underestimated in five (2%). Furthermore, CT angiography depicted mural changes, including wall thickening, calcification, and mural thrombi, not seen with conventional angiography. The sensitivity and specificity of CT angiography in the diagnosis of Takayasu arteritis were 95% and 100%, respectively. CONCLUSION: CT angiography clearly depicts both luminal and mural changes in the thoracic aorta and its major branches and has a high accuracy in the diagnosis of Takayasu arteritis.

Adolescent↗