Mucoepidermoid tumor of the lung: CT appearance.

Mucoepidermoid tumor of the lung is a rare endobronchial neoplasm with a wide spectrum of appearance. We present a case report and describe the plain film and computed tomography (CT) findings.

Can the radiologist recognize Helicobacter pylori gastritis?

To evaluate radiologic findings of Helicobacter pylori (H. pylori) in the upper gastrointestinal (UGI) tract, we retrospectively reviewed consecutive records of 676 symptomatic adults with gastric biopsies (224 positive) and 150 symptomatic adults with rapid urease tests (57 positive). All the UGI series of patients with positive biopsies or urease tests for H. pylori were compared with the UGI series of patients with negative urease tests. UGI examinations were evaluated blindly by two gastrointestinal radiologists without knowledge of clinical findings, original radiologic interpretations, or test results. They agreed that 8 of 18 (44%) UGIs of patients with H. pylori had abnormally increased gastric folds in the fundus, body, or antrum as compared with none of 14 (0%) UGIs of patients without H. pylori (p < 0.01) (P.P.V. = 1.0). Interobserver agreement was good (kappa = 0.63). Endoscopy in the eight patients with radiographic evidence of enlarged gastric folds all demonstrated marked abnormalities such as prominent gastric folds, gastric erythema, erosions, or peptic ulcers. Our findings indicate that enlarged gastric folds on the UGI series of a symptomatic adult are very suggestive of H. pylori gastritis.

Fluoroscopically guided suprapubic cystostomy in complex urologic cases.

PURPOSE: To evaluate the efficacy of percutaneous suprapubic cystostomies performed by the interventional radiologist for complex urologic cases. MATERIALS AND METHODS: A retrospective analysis was done of the 25 cases referred to the radiology department for suprapubic cystostomies. The patients were referred because of unsuccessful placement or malposition of a suprapubic cystostomy tube. The procedure was performed with the Seldinger technique by using a 21-gauge needle for initial antegrade puncture and subsequent tract dilation and placement of 10-24-F catheters. RESULTS: In 24 of 25 cases (96%) the suprapubic cystostomy was successfully performed. After suprapubic cystostomy, eight patients (32%) underwent additional ancillary procedures by urologists through the suprapubic tract. The only major complication was perivesical fluid collection in one patient (4%), which was subsequently drained. Seventeen patients (68%) had transient hematuria. CONCLUSION: Percutaneous suprapubic cystostomy performed under fluoroscopic control is an effective and safe procedure ideally suited for the interventional radiologist, especially in complex urologic cases.

Emergency percutaneous nephrostomy: technical success based on level of operator experience.

PURPOSE: The outcomes of emergency percutaneous nephrostomy procedures performed by operators with different levels of experience were analyzed. PATIENTS AND METHODS: A prospective study of 160 patients undergoing 169 emergency percutaneous nephrostomies was conducted. Three categories of operator experience were compared based on the number of percutaneous nephrostomies performed each year (level 1 = more than 20, level 2 = 10-20, or level 3 = less than 10). RESULTS: The level 1 operators (mean fluoroscopy time, 2 minutes; mean procedure time, 25 minutes) achieved success in 141 of 142 cases (99%) and failed in one case (1%), which was repeated successfully the next day. The level 2 operators (mean fluoroscopy time, 6 minutes; mean procedure time, 35 minutes) achieved initial success in all of 15 cases (100%), but three cases (20%) were repeated the next day because of catheter migration or malposition. Level 3 operators (mean fluoroscopy time, 10 minutes; mean procedure time, 42 minutes) were successful in 10 of 12 cases (83%), but in four cases (33%) the procedure had to be repeated. CONCLUSION: The experience of the operators played little role in the initial success rate of the procedure after they had performed 10 or more per year. However, the level of experience did influence the number of procedures that needed to be repeated, the prevalence of minor complications, and the mean fluoroscopy and procedure time.

Progressive Bochdalek hernia with unusual ureteral herniation.

An asymptomatic case of a Bochdalek hernia with progressive herniation of the right ureter is presented. The diagnosis was made by computed tomography (CT).

Computed tomography of normal and calcified coronary arteries.

The association between coronary artery calcification (CAC) and coronary artery disease is well established. The objectives of this article are to define the cross-sectional anatomy of the coronary arteries and to demonstrate the prevalence of CAC as seen on routine computed tomography (CT) of the thorax. A CT scan of a cadaver heart was performed in normal anatomic position. Additionally, a retrospective analysis of 103 consecutive thoracic scans was done by three experienced radiologists. The cross-sectional anatomy of the coronary arteries is described based on both these studies, and the prevalence of coronary calcification from the retrospective review was determined. The left anterior descending was the most commonly calcified artery (43% of all patients) followed in order by the left coronary (37%), circumflex (33%), and right coronary (20%). Seventy-nine percent of patients older than age 65 demonstrated coronary calcification on CT. This prevalence approaches that of reported autopsy series. Knowledge and understanding of the cross-sectional anatomy of coronary arteries is essential for detection of coronary artery calcification. We recommend that the presence of CAC should be reported on all thoracic CT scans because coronary calcification may signal unsuspected coronary artery disease.

Postpartum ovarian vein thrombosis.

Ovarian vein thrombosis is a rare occurrence in the postpartum period. Two cases of postpartum ovarian vein thrombosis are presented. The differential diagnosis is extensive because many diseases can present with similar symptoms. Early diagnosis is essential for appropriate treatment and prevention of the potential sequelae that can occur. Computerized tomography with contrast is the optimal imaging modality for the diagnosis.