The American journal of roentgenology, radium therapy, and nuclear medicine最新文献

During the decade, February, 1965, through February, 1975, 248 patients underwent renal transplantation at the Duke Medical Center. One hundred twenty-five were living related recipients, while 123 were cadaveric recipients. Eleven patients developed ileocolonic perforation. Six cases were felt to represent non-immunologic etiologies while the remaining 5 were felt to be associated with the allograft response and high dose steroid therapy. Only 3 of the patients survived this complication and in each case the perforation was localized. High dose steroid therapy interferes with prompt diagnosis and severely impairs successful treatment. Radiologists must be familiar with the problem of ileocolonic perforation in patients on steroid therapy, must have a high index of suspicion of the site of perforation, and must recommend and complete water soluble contrast examination for establishment of the diagnosis. Early diagnosis, prompt surgical intervention, and discontinuation of immunosuppressive therapy are recommended.

Arteriomegaly describes tortuous, ectatic, irregular vessels with prolonged blood flow. Seven cases of this entity are outlined with representative case reports. The increased incidence of aneurysms, thrombosis and embolization is noted in this and other series. The possibility that tortuous vessels may be confused with aneurysms on examination is also discussed. Due to the prolongation of blood flow, adequate arteriographic evaluation may be quite difficult.

Peripheral vascular perfusion scan during rest and reactive hyperemia does not necessarily offer the same information as the arteriogram or the clinical assessment of the peripheral pulses. The information obtained from the peripheral vascular perfusion scan offers potentially clinically useful information regarding the physiologic significance of various arterial lesions to the surgeon in selection of his therapeutic approach. The peripheral vascular perfusion scan uniquely and under varied physiologic conditions permits assessment of the effect of arterial disease on the distribution of perfusion within the extremity. The peripheral vascular perfusion scan is not in competition with, but is complementary to, arteriography and clinical assessment of the patient with peripheral vascular disease.

Isolated schwannomas may occur in many different situations within the central nervous system. Most neurilemmomas are benign, and enucleation after longitudinal dissection of the nerve will usually affect a cure. It is for this reason that the roentgenological appearances should be appreciated and this diagnosis considered so as to attempt total surgical removal.

Aneurysms of the sinuses of Valsava are neither rare nor always fatal. They are of three types: congenital, acquired, and associated with cystic medial necrosis. Each can be recognized by its characteristic appearance on plain roentgenograms and arteriography. With surgical repair, the congenital type and that which is the result of cystic medial necrosis carry a good prognosis for the patient. With the acquired type, usually syphilitic, the prognosis with conservative management is good.

Three patients with cavernous hemangiomas of the kidney all presented with hematuria. In each there was found a poorly defined renal medullary mass with displacement of the calyces and renal vessels and paradoxical hypovascularity of the mass. This rare, benign tumor of the kidney should be considered in the presence of this characteristic clinical picture.

In our experience, the low success rate of 75Se parathyroid studies does not justify continuance of the test as a routine diagnostic procedure. The initial results using the 99mTc O4--131I subtraction technique are encouraging but further experience is required in order to ascertain whether this procedure will justify a place as a routine test in the localization of parathyroid adenoma.

Localized cutaneous as well as unifocal and multifocal systemic sporotrichosis may all produce roentgenographic findings. Localized cutaneous nodules may occasionally extend to the bone below producing a locally erosive lesion similar to those more commonly found in blastomycosis. More frequently, sporotrichosis involves the joints, either alone or with accompanying skin nodules. The joint changes are those of a pyogenic arthritis of the knees, elbows, hands, or feet which is difficult to distinguish from pyarthrosis produced by other organisms. The pulmonary findings depend upon whether or not the lung is the only site of infection. If there are no other areas of involvement, the pulmonary findings may be indistinguishable from those of secondary tuberculosis. However, if the skin on joints are also involved, small nodules appear and apparently do not proceed to cavitation.

Two cases of ectopic, partly intrathoracic kidneys are discussed. One case represents bilateral ectopy, an extremely rare condition. This anomaly deserves consideration because a correct diagnosis can save the patient extensive examinations and possibly thoracic surgery.

The tethered conus is a real and treatable entity. It presents with a variable though fairly constant symptom complex. The diagnosis is probably not even considered in many patients with this condition. Recognition of the possibility of this condition by both the clinician and radiologist is needed. Properly performed oil or air myelography is the only method of preoperative confirmation of a tethered conus and should be done in all cases where it is suspected.