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

Cervical aortic arch anomaly is a rare congenital entity. The aortic arch extends into the soft tissues of the neck before turning downward on itself to become the descending aorta. Nineteen cases have been previously reported in the world literature with one more presently in publication. We have collected six additional cases, in four of which the cervical arch was located on the left. Formerly the left cervical aortic arch was felt to be much less common than the right. It now appears that they have equal incidence. Four of our cases were also associated with cardiac anomalies, and this coincidence has not been previously reported.

1. Two additional cases of presumed, thorium-induced hemangioendothelioma of the liver are reported. 2. The angiographic pattern of large venous lakes conforms closely to the pathologic descriitions of this malignancy. 3. To our knowledge, angiography of the thorotrast (and vinyl chloride) liver, before the clinical evolution of malignancy, has not been recorded and may provide information of prognostic and therapeutic value. 4. Incidental identification of thorium deposits in the tissues of clinically healthy patients creates perplexing "inform and consent" problems. Presumably, these must be solved on an individual basis. 5. Because the use of thorotrast has been discontinued since the early 1950s, all physicians reviewing chest and abdominal roentgenograms should be aware of the characteristic appearance of human thorotrast deposits, especially in the liver, spleen and celiac lymph nodes. 6. The number of living thorotrast "carriers" and previous deaths from thorotrast related malignancy seems highly uncertain at this time.

Six cases of nontraumatic chylothorax secondary to filariasis, postinflammatory thoracic duct obstruction, idiopathic lymphangiectasis with lymph node hypoplasia, lymphangioma and lymphoma (2 cases) are reported. All cases were studied by lymphangiography, which provided considerable diagnostic information. In those cases which are undiagnosed at the time the chylothorax is discovered, a lymphangiogram should be carried out prior to any therapeutic measures.

Thirty-eight cases with direct or indirect signs of hilar masses were investigated by roentgenologic, radioisotopic and surgical methods. Reasonable correlation between tomography and scintigraphy was confirmed, substantiating their complementary nature. Bronchogenic carcinoma of the central airways was most frequent among the hilar masses. Masses as well as other involvement of the bronchovascular structures of the hilum on conventional tomography were confirmed by the gallium-67 scan, and inhalation and perfusion scintigraphy. Some cases which simulated bronchogenic carcinoma were presented. Hilar masses without destruction of the bronchovascular structures showed normal inhalation and perfusion scintigrams with positive gallium-67 accumulation. These lesions were metastatic cancer, malignant lymphoma, and sarcoidosis. If these diseases involve the airways and the vessels of the hilum, differentiation from bronchogenic carcinoma may naturally be difficult.

Diagnostic ultrasound has an important place to play in aiding the obstetrician who has an abortion practice. It is most useful in accurately dating the time of conception. Based on sonographic dating, an abortion may be possible in patients with multiple pregnancy or in whom there is a mass in addition to pregnancy. The performance of a saline or urea abortion is made easier since the precise site of the uterus can be mapped out. Once an abortion has commenced, the presence or absence of retained products can be easily verified by ultrasound.

Some cardiovascular lesions may result in tracheobronchial obstruction and many of these will commonly be associated with infantile lobar emphysema (ILE). By contrast a relatively smaller percentage of cases of ILE results from vascular compression. We offer a new term, "congenital avalvular pulmonary artery (CAPA)," to describe the complex of the absent pulmonary valve and the concomitant marked pulmonary artery dilatation because CAPA is more descriptively inclusive of the abnormality of the artery beyond the valve. The diagnostic correlation of CAPA and ILE is of considerable importance since the initial presentation of CAPA is usually as ILE and the recognition of a triangular or rounded hilar density should raise suspicion for CAPA even before clinical signs become evident. Differential diagnosis must include other causes of ILE including infantile lobar emphysema with bronchial atresia.

In 120 patients who had 127 transumbilical catheterizations of the portal vein, 33 of pancreatic veins, and 15 for other portal tributaries, the surgical success rate was 91 per cent over-all, increasing to 95 per cent during the last year. Catheterization was made with the same technique as is used for arteriography. The most important complication was thrombosis of the portal vein, giving slight transient symptoms in 2 patients. Other complications were wound infection, suture granuloma, herniation in the linea alba, bleeding from the operative wound, and subintimal injections. As the technique may yield good results in studies of drug resorption, flow studies, detection of metastases, and investigation of pancreatic veins, it seems justified in suitable patients despite the complication rate. None of the complications produced lasting disability.

In 14 patients with an indwelling catheter, 48 different determinations of bladder volume were made using 5 different ultrasonic methods. The simplest procedure, the largest sagittal diameter of the bladder in the median plane, gave only a rough estimate of the bladder volume. The product of bladder depth, height, and width, as determined from transverse and sagittal scans, showed the best correlation to the true bladder volume (r equals 0.90). Computerized reconstruction of multiple serial cross sections proved less accurate than the much simpler depth, height, width product. None of the methods for quantitation of small volumes was good, but qualitative determination of small volumes was accurate.

Two cases of submucosal hemorrhage in the renal pelvis and ureter are presented. The roentgenographic appearance was identical to that of pyeloureteritis cystica but without evidence of urinary tract infection and, in 1 case, the submucosal impression resolved rapidly. When nodular, submucosal filling defects are demonstrated in the renal collecting system in the clinical setting of anticoagulant therapy or trauma, a diagnosis of submucosal hemorrhage should be considered.