ACTH-producing apudoma metastatic to the liver.

A young man presented with combative psychosis and elevated levels of plasma adrenocorticotropic hormone (ACTH). A solitary vascular pancreatic mass and diffuse vascular hepatic nodules were demonstrated on selective splenic and hepatic arteriograms. These classic angiographic findings are used to emphasize the role of angiography in initial radiographic evaluation and to summarize the angiographic appearance of functioning pancreatic adenomas. Even though this is an aggressive tumor, early diagnosis and intensive treatment may allow prolonged remission, if not cure.

Streptokinase: an antidotal case.

The author discusses the use of streptokinase in a patient with distal occlusion of the trifurcation vessels near the ankle mortise.

The small gallbladder: hepatic spill phenomenon.

Ninety percent of patients with serum bilirubins above 4 mg/100 ml will not excrete cholangiographic contrast media.(1) Because of their clinically evident icterus, these patients are easily identified and decreased hepatic function can be expected. The anicteric patient with marginal hepatic reserve presents more difficulty in clinical identification. Significant impairment may not be evident until cholangiographic examination (often performed for presumed gallbladder disease) shows increased renal excretion of contrast. Appreciation of this radiographic manifestation of impaired hepatic reserve may be a useful adjuvant to clinical diagnosis.

Angiographic density averaging in a case of renal artery intimal fibroplasia and recanalized thrombus.

The angiographic appearance of renal artery, intimal fibroplasia with recanalized luminal thrombus is presented. Criteria for diagnosis are discussed.

The IIIA1b right aortic arch: angiographic and computed tomographic evaluation.

A case of type IIIA1b mirror-image right aortic arch is described and the complementary role of angiography and computed tomography suggested.

Comparison of intravenous digital subtraction angiography to conventional aortography in patients with abdominal aortic aneurysm.

Evaluation of intravenous digital subtraction angiography (IV DSA) in patients with abdominal aortic aneurysm was performed by obtaining catheter aortograms immediately before DSA studies in ten patients. Diagnostic images were obtained in nine of ten digital subtraction examinations. Although repeat injections were necessary in six DSA and three conventional aortography cases for adequate imaging of both cephalad and caudal extension of the aneurysm, average contrast dose was 53 cc (62 cc in standard catheter studies). Renal artery stenosis was diagnosed by DSA in two of three vessels, multiple renal arteries were demonstrated by both modalities in two cases. Digital subtraction and conventional aortographic findings were proved at surgery. Intravenous DSA was shown to be useful in the preoperative evaluation of patients with abdominal aortic aneurysm.