Hepatobiliary study. Left hepatic lobe herniation into the thorax.

After a motor vehicle accident, an 18-year-old woman reported cough and dyspnea. A chest radiograph revealed an intrathoracic mass blending with the cardiac shadow. Hepatobiliary imaging showed that this was due to herniation of the left hepatic lobe and a portion of the right lobe and gallbladder into the right hemithorax.

Prenatal education in the work place.

Advances in neonatal care have improved survival rates among premature and low-birth-weight (LBW) infants, but highly technical care for these infants costs more than $2 billion a year in the United States. The incidence of premature and LBW infants can be reduced by prenatal education programs that focus on nutrition, obtaining prenatal care, avoiding dangerous substances, and recognizing preterm labor. In an effort to contain health care costs, many companies self-insure employee health benefits and offer health promotion programs designed to improve life style behaviors. This article examines providing a prenatal education program in the work place as a way of reducing the incidence and costs of prematurity and low birth weight.

Recognition of distinctive patterns of gallium-67 distribution in sarcoidosis.

Assessment of gallium-67 (67Ga) uptake in the salivary and lacrimal glands and intrathoracic lymph nodes was made in 605 consecutive patients including 65 with sarcoidosis. A distinctive intrathoracic lymph node 67Ga uptake pattern, resembling the Greek letter lambda, was observed only in sarcoidosis (72%). Symmetrical lacrimal gland and parotid gland 67Ga uptake (panda appearance) was noted in 79% of sarcoidosis patients. A simultaneous lambda and panda pattern (62%) or a panda appearance with radiographic bilateral, symmetrical, hilar lymphadenopathy (6%) was present only in sarcoidosis patients. The presence of either of these patterns was particularly prevalent in roentgen Stages I (80%) or II (74%). We conclude that simultaneous (a) lambda and panda images, or (b) a panda image with bilateral symmetrical hilar lymphadenopathy on chest X-ray represent distinctive patterns which are highly specific for sarcoidosis, and may obviate the need for invasive diagnostic procedures.

Rapid ventricular filling in left ventricular hypertrophy: I. Physiologic hypertrophy.

The effects of endurance training on the diastolic properties of the left ventricle were examined by comparing left ventricular filling rates in 11 male distance runners and 12 age-matched nonathletic control subjects selected to have nearly similar heart rates at rest. Maximal oxygen consumption was 69 +/- 11 ml/kg-min for the athletes and 48 +/- 8 ml/kg X min for the control subjects (p less than 0.001). Left ventricular end-diastolic dimension, posterior wall thickness and mass were determined by echocardiography, and average left ventricular filling rate was determined with a nonimaging scintillation probe. Electrocardiographic voltage was significantly greater in the athlete group than in the control group (sums of the voltages of the S wave in lead V1 and the R wave in lead V5 were 40 +/- 10 and 26 +/- 7 mV, respectively) (p less than 0.001), whereas ejection fraction was similar in the two groups. Despite a modest degree of left ventricular hypertrophy in the athlete group compared with the control group (left ventricular mass index 127 +/- 30 and 82 +/- 13 g/m2, respectively) (p less than 0.001), the average left ventricular filling rate was similar in the two groups (2.53 +/- 0.34 versus 2.38 +/- 0.29 end-diastolic counts/s, p = NS). There was no trend for the athletes with a higher left ventricular mass to exhibit a slower filling rate. These findings demonstrate that unlike pathologic hypertrophy associated with chronic hemodynamic over-loading, physiologic left ventricular hypertrophy is not accompanied by slowed left ventricular diastolic filling.

Tc-99m RBC blood-pool imaging demonstrates umbilical vein in portosystemic shunt.

Dynamic hepatic scintigraphy in a patient with longstanding ethanolism revealed hepatofugal drainage of the liver area. That this pathway represented the umbilical vein was shown by subsequent blood-pool images. The umbilical vein drained the left portal vein into venous channels in or near the anterior abdominal wall. These channels proceeded through epigastric vessels into the right femoral/iliac venous system. The umbilical vein may serve as a shunt from the portal system to the systemic circulation in cases of portal hypertension. Blood-pool imaging has a potential role in clarifying possible venous channels identified by hepatic scintiangiography, and can suggest the presence of portal hypertension when these vessels are visualized.

Scintigraphic appearance of axillofemoral and femorofemoral bypass grafts.

The scintigraphic appearance of axillofemoral and femorofemoral bypass grafts was reviewed in three cases in which the grafts were patent and intravascular radiotracers defined their course. In a fourth case, the axillofemoral graft was occluded and an aberrant vessel was identified (probably acting as a physiological shunt).