Pancreaticoduodenal tuberculosis simulating metastatic ovarian carcinoma.

A patient from Thailand presented with symptoms suggestive of peptic ulceration. Radiology showed an ulcerated duodenal stricture, a pancreaticoduodenal mass and extensive retroperitoneal lymphadenopathy suggestive of metastatic carcinoma. Tuberculosis was diagnosed only at laparotomy. The incidence of tuberculosis is increasing, and alimentary tuberculosis should be considered in patients from populations at risk presenting with obscure abdominal complaints or unexplained radiologic findings.

Radiologic appearance of recurrent ileal Crohn disease.

BACKGROUND: Postoperative recurrence of Crohn disease is a common problem. It has been assumed that the radiologic patterns are similar in de novo and recurrent ileal disease, but there has been little in the literature to actually confirm this belief. METHODS: We retrospectively reviewed the small bowel examinations of 105 consecutive patients with a proven diagnosis of Crohn disease: a control group of 47 patients with no prior surgery and a postoperative group of 58 patients with resections. Of the latter, 22 had ileocecal or ileocolonic resections and 36 patients had ileocecal or ileocolonic and extensive enteric resections. We examined the disease sites and compared the disease patterns in both groups. RESULTS: Fifty-six of 58 (97%) postoperative patients had anastomotic recurrences with proximal extension from 3 to 25 cm, with a mean of 10.5 cm; none showed distal disease extension. Two (3%) had enteric recurrences with neoterminal ileal sparing. There were no statistically significant differences in the length of distal/terminal ileal disease and the frequency of skip lesions in de novo and recurrent disease. There were lower frequencies of mucosal thickening, ulceration/ulceronodular mucosa, sacculation, loop separation, sinuses, and masses and a higher frequency of strictures in recurrent disease than in de novo disease. There was also a lower frequency of ulceration or ulceronodular mucosa after extensive resection than after limited resection. CONCLUSION: Postoperative patients with ileal Crohn disease show a marked preponderance for anastomotic recurrence with proximal disease extension. There are significant differences in disease patterns in patients with de novo and recurrent disease.

Radiologic treatment of a patient with the "steakhouse syndrome": case report.

A method of treating the "steakhouse syndrome" (esophageal obstruction due to meat impaction), employing air insufflation via a nasoesophageal tube with esophageal hypotonia, is described as applied in one patient. The technique is a modification of tube esophagography and can be attempted when the combination of an effervescent agent and a hypotonic drug has been unsuccessful.

Placental chorioangioma, an unusual cause of polyhydramnios: antenatal diagnosis.

I report a patient with placental chorioangioma producing third trimester polyhydramnios. The ultrasonographic diagnosis and the complications of this tumor are discussed.

Segmental renal venous catheterization: technical note.

I describe a technique for superselective catheterization of the renal segmental veins which does not require specialized equipment.

Recurrent hepatoma with CT, MRI, and angiographic correlation.

Two patients who underwent successful resections for uninodular hepatomas in non-cirrhotic livers were readmitted with late recurrences. Both had multiple imaging procedures prior to treatment including computed tomography, magnetic resonance imaging, and angiography. I recommend periodic ultrasonography and alphafetoprotein assay in the follow-up of patients who have had a hepatoma resected and I indicate when additional imaging methods are required.

Peroral pneumoileum in patients with ileostomy.

Peroral pneumoileum extends the peroral pneumocolon technique to patients with ileostomy to improve visualization of the ileum when the small-bowel examination is limited by poor distension, overlapping loops or adhesions. The author describes the technique in detail and presents the findings for 25 patients (10 men and 15 women) examined for suspected ileostomy dysfunction, recurrent Crohn's disease or ileal obstruction remote from the stoma. In only one patient was retrograde single-contrast enema required in addition to the antegrade small-bowel series with peroral pneumoileum. In seven of the patients, the demonstration of abnormalities with this technique influenced subsequent management. Peroral pneumoileum overcomes several of the limitations of antegrade and retrograde examinations and enables complete jejunoileal assessment with a single radiologic procedure.

Crohn's disease of the small intestine with polypoid configuration.

We describe three patients with Crohn's disease of the small intestine with a polypoid configuration. In two patients, the polypoid masses were the only radiologic abnormalities and were suggestive of jejunoileal lymphoma and terminal ileal adenomas. The diagnosis of Crohn's disease was established only at laparotomy. In the third patient, a polypoid mass simulating a sessile adenoma was seen along with other typical features of ileitis and was recognized preoperatively as a manifestation of the ileitis. The resected ileal segments of all three patients showed mural thickening, luminal narrowing and distortion, and mucosal ulceration and fissuring. The asymmetry of the mural thickening and the resultant luminal narrowing simulated sessile polyps to which mucosal ulceration and fissuring gave a lobulated appearance.

Fetal thoracic circumference: a prospective cross-sectional study with real-time ultrasound.

We report a prospective cross-sectional study of ultrasound fetal chest growth during normal pregnancy. The fetal chest circumference was measured in 100 normal pregnancies from 13 to 41 weeks' gestation. Nomograms of chest circumference versus gestational age and femur length were constructed. Data from 18 cases at risk for pulmonary hypoplasia indicated that the fetal chest circumference measurement may be useful in the antenatal prediction of lethal or clinically severe pulmonary hypoplasia.

Carcinoma of the fallopian tube presenting as renal failure: case report.

We describe a patient with carcinoma of a fallopian tube initially presenting with oliguric renal failure. Urinary tract symptoms are uncommon as a result of this rare tumor, and renal failure due to bilateral ureteral obstruction by nodal metastases has not been reported previously as a complication.

Shigella colitis with radiological and endoscopic correlation: case report.

We report a patient with acute colitis secondary to Shigella flexneri infection. Radiologic and endoscopic studies were obtained during and after the patient's clinical recovery. Hypotonic air contrast barium enemas were helpful in evaluating the severity and extent of the disease proximal to the segment viewed by flexible sigmoidoscopy. They showed pseudopolyposis, which has not been previously reported in the acute phase, and other mucosal abnormalities which persisted long after clinical recovery.

Crohn's disease of the proximal small intestine: radiologic findings in 55 patients.

Radiographs of the upper gastrointestinal tract and the small bowel of 55 patients were reviewed to identify changes associated with proximal enteric Crohn's disease. Five patients had gastroduodenitis, 18 duodenitis, 14 jejunitis and 18 jejunoileitis. Nineteen had previously undergone ileocecal resection. The terminal ileum was spared in 11 of the 36 patients who had not undergone ileocecal resection; of these, 9 had jejunoileitis, 1 jejunitis and 1 jejunitis secondary to colitis with colojejunal fistulas. In just over 80% of the patients with jejunal disease and all the patients with primary jejunal disease in whom the terminal ileum was spared, the condition developed before the patients reached 30 years of age. Duodenal disease was not associated with any particular age group, and duodenitis was invariably a "skip" lesion in patients with disease of the terminal ileum. The diagnosis of proximal enteric Crohn's disease depended on the presence of one or more characteristic lesions in the jejunum or terminal ileitis associated with a duodenal or jejunal abnormality. Ulceration occurred in 88% of the patients with a diseased terminal ileum but was less common in patients with a diseased duodenum (occurring in 43%), jejunum (in 53%) or proximal ileum (in 57%). Fistulas in the terminal ileum complicate ulceration in 10% to 26% of patients, and sinuses complicate ulceration slightly more often, but proximal enteric fistulas or sinuses occurred in only four (7%) of the patients described here.(ABSTRACT TRUNCATED AT 250 WORDS)

Sonographic diagnosis of leiomyosarcoma of the inferior vena cava: correlation with computed tomography and angiography.

We describe a patient with leiomyosarcoma of the inferior vena cava. There has been no previous report of the sonographic diagnosis of this rare entity.

Double-contrast hypotonic duodenography after enteroclysis.

The authors describe a technique for obtaining a double-contrast hypotonic duodenogram after a small-bowel enema examination. They have used this technique successfully in patients with unexplained gastrointestinal bleeding and to assess duodenal involvement in patients with Crohn's disease.

Linitis plastica of the alimentary tract and scrotum.

We present a unique case of diffuse linitis plastica involving the gastrointestinal tract and the scrotal skin of a 63-year-old man. The radiologic and pathologic features of this entity are discussed together with a review of the pertinent literature.

Fine-needle aspiration biopsy of an islet cell tumour simulating pancreatic carcinoma.

The importance of distinguishing between malignant islet cell tumour and pancreatic carcinoma is emphasized in this report of a 57-year-old woman who presented with an epigastric mass. Clinically and radiologically it was diagnosed as a pancreatic adenocarcinoma. A fine-needle aspiration biopsy specimen obtained under ultrasonic guidance showed tumour cells suggestive of an islet cell tumour. Immunostaining and electron microscopy were performed on the aspirate. The tumour cells stained positive with antibodies to keratin, glucagon and gastrin; ultrastructural examination revealed neurosecretory granules, confirming the diagnosis of an islet cell tumour. Angiography was performed to assess the possibility of debulking the mass. This case demonstrates the value of immunohistochemistry and electron microscopy on fine-needle aspiration biopsy specimens of the pancreas to differentiate islet cell tumours, which are potentially curable, from pancreatic adenocarcinomas, which carry a 5-year survival rate of less than 2%.

Venous intravasation of barium: CT findings.

Portal venous barium and air intravasation occurred during an air contrast enema in a man with ulcerative colitis. Abdominal plain radiography and CT subsequently showed increased hepatic density. Computed tomography also showed colonic intramural and pericolic nodal or venous barium, increased splenic density, and pulmonary arterial barium. The patient's course was benign because little barium embolized beyond the liver into the systemic circulation.

A comparative assessment of tube esophagography with double-contrast esophagography in the detection of reflux esophagitis.

We undertook a prospective study comparing the sensitivities of double-contrast and tube esophagography in 34 patients with gastroesophageal reflux and compared our findings with those at endoscopy. Neither test detected changes accurately in mild inflammation; however, they both became more sensitive as the severity of esophagitis increased. The sensitivity of both tests increased from 0% in grade 2 to 86% in grade 4 esophagitis. The tube esophagogram demonstrated inflammatory changes better than the double-contrast esophagogram in only 18% of the 34 patients, all with grade 3 or 4 esophagitis, despite the elimination of the barium pool in the distal esophagus and improved distension of the esophagogastric junction. Endoscopy is still the most reliable means of diagnosing and grading esophagitis.

The total fundoplication gastroplasty: surgical procedure and radiologic appearance.

The total fundoplication gastroplasty (TFG) consists of a combination of an esophagus-lengthening Collis gastroplasty and suturing of the gastric fundus to the esophagus and neo-esophagus to produce a stable intra-abdominal segment together with a complete Nissen fundoplication tailored in length to control reflux and avoid overcompetence. We studied 50 patients at least three months after TFG with an upper gastrointestinal examination and a tube esophagogram. Tube esophagography enhances distension of the esophagus and esophagogastric junction and eliminates the barium pool often seen in the distal esophagus in double-contrast esophagography. With this technique we were better able to understand the radiologic anatomy of the esophagogastric junction following TFG. Tube esophagography provided additional radiologic information in the five patients (10%) with preoperative peptic strictures of the esophagus. We describe the surgical and radiologic anatomy of the TFG, the technique of postoperative radiographic examination, and the postoperative problems we have encountered.

NSAID injury to the small intestine.

PURPOSE: To identify the clinical and radiologic findings in patients with diaphragm-like strictures in the small bowel. PATIENTS AND METHODS: We reviewed the histories, radiologic findings, and pathologic findings in two men and two women, all in their sixties, with a history of long-term nonsteroidal antiinflammatory drug (NSAID) or aspirin (ASA) usage and one or more radiologically demonstrated diaphragm-like strictures in the small bowel. RESULTS: Two patients had long histories of NSAID usage, and two of ASA usage. One NSAID user had a long segment of jejunal involvement, and the other three had short segments of duodenal involvement. The ASA users presented with symptoms of esophageal disease, the small bowel lesions were unexpected, and ASA usage was not initially elicited. In one NSAID user and one ASA user, broader strictures with humps rather than diaphragms were also seen producing a lifesaver-like or bagel-like configuration. CONCLUSIONS: Multiple diaphragm-like strictures can occur in NSAID injury and are pathognomonic except in the rare patient with ulcerative enteritis complicating celiac disease. Single or few diaphragm-like strictures can occur in NSAID injury and peptic ulceration. ASA should be considered an NSAID with regard to small-bowel toxicity. A careful medication history is required when an unexplained small bowel abnormality is seen radiologically, and a dedicated small bowel examination is required when NSAID injury is suspected.