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

Experience with a wide variety of pelvic-abdominal masses indicates that good quality tomography during high dose urography permits separation of solid from cystic lesions in almost all cases, even with minimal mass opacification. Evaluation of surface contour, absence or presence of a wall and its features, opacification, calcification, and uterine status provides the framework for characterization of the mass. Multiple masses can be identified and evaluated separately. While titration of the above criteria permits an accurate assessment independent of the clinical diagnosis, the latter information is important in separating a probable abscess from other cystic lesions. Since urography continues to be a pivotal preoperative roentgenologic investigation (ureteral status, pelvic kidney exclusion, etc.), the addition of tomography provides an added dimension to its usefulness. With the exception of the premenopausal female in whom radiation exposure is a consideration, tomography appears to preclude the routine necessity for subsequent ultrasound study which has been used to separate cystic from solid lesions.

Roentgen studies in a group of 131 patients on maintenance hemodialysis reveal renal osteodystrophy in 25 patients (19 per cent). In 24 patients of the latter group (98 per cent), the various manifestations of renal osteodystrophy appear in the bony pelvis. These include: osteomalacia; osteitis fibrosa; osteosclerosis; dialysis osteopenia; and extraosseous calcifications. Some of the changes, i.e., bending of bone, Looser's lines, metaphyseal fractures and dialysis osteopenia, are due, at least in part, to the weight bearing nature of the bony pelvis. These findings are ararely, if ever, seen in the digits or in other non-weight bearing bones. It is therefore proposed to evaluate the bony pelvis, together with the magnification digital roentgenogram, when a less costly and less time consuming skeletal survey is needed in hemodialized patients.

Xerography of the radical vulvectomy specimen provides a permanent and visible record of the major lymph node distribution within the specimen. Such documentation is valuable to both pathologist and surgeon alike when making decisions regarding the necessity of further therapy. The combined effort represented by this "team" approach results in a high degree of accuracy not available with other techniques. Only if this kind of lymph node assessment is applied to each and every case will it be possible to evaluate accurately the logic and efficacy of the new therapeutic concepts regarding invasive carcinoma of the vulva.

Two cases of a large schwannoma of the lesser omental sac are described. One arose from the lesser omentum itself. This schwannoma also had roentgenographically visible calcifications, a finding never before reported to have been seen in the abdomen. Emphasis is upon the uniqueness of the site of the tumor.

All pregnancies with a breech or transverse lie should be examined roentgenologically, at least after the onset of labor, and those in whom hyperextension of the neck persists should be sectioned to avoid the real danger of injury to the cervical cord incurred in vaginal delivery. The radiologist should not assume a seriously deformed fetus just from the hyperextension; most of these fetuses are otherwise normal.

Detailed angiographic findings in 2 cases of proved sprue are described. There are dilatation of the superior mesenteric artery and its small bowel branches selectively, and increased capillary blush. Early draining into dilated veins is also noted. These findings are similar to those of the superior mesenteric arteriogram performed with pharmacological vasodilators. This similarity suggests that the dilated vessels in non-tropical sprue may be due to capillary dilatation.

Clinical and roentgenographic features of renal vein thrombosis are discussed. The authors' experience with 17 cases is presented. The roentgenologist with a high degree of suspicion can, by correlation of clinical and urographic findings, make the specific diagnosis of renal vein thrombosis in a high percentage of cases.

The plain roentgenographic and angiocardiographic features of 15 patients with Ebstein's anomaly of the tricuspid valve were reviewed. Of note on the plain roentgenogram was the fact that the "posterior bulge" seen on the lateral view was demonstrated to be due to either a markedly enlarged right atrium or the posterior displacement of normal left heart structures. The angiocardiographic features described in the literature were reviewed. Two main features seen were the "sail-like" appearance of the anterior leaflet of the tricuspid valve, which sometimes produces a tumor like picture, and the 2 notches seen when the ventricle contracts. One notch corresponds to the true tricuspid annulus. The other represents the site of attachment of the displaced tricuspid valve. The previously undescribed features were noted: (a) all three leaflets could sometimes be identified; (b) fenestrations in the anterior leaflet were demonstrated in 5cases; and (c) the sinus portion of the ventricle was sometimes filled in a retrograde fashion from the infundibular chamber.

Two cases of Crohn's disease involving the esophagus are described. Both patients had Crohn's disease elsewhere. Multiple intramural fistulous tracts are seen in both patients, and this is a characteristic feature of Crohn's disease. One patient developed a spontaneous esophago-bronchial fistula. Even though the esophageal involvement of Crohn's disease is rare, it should be suspected when a chronic esophageal inflammatory lesion develops in a patient who has Crohn's disease elsewhere, especially without hiatus hernia or other chronic disease.