Magnetic resonance imaging in young adults with cystic fibrosis.

It is difficult to distinguish between atelectasis, mucoid impaction, and peribronchial inflammation on chest roentgenograms (CXR) in patients with cystic fibrosis (CF). Differentiation between hilar adenopathy and prominent pulmonary vessels is also sometimes difficult. We studied 16 young adults with CF using both magnetic resonance imaging (MRI) and CXR to evaluate the usefulness of MRI in this clinical context. The same patients were studied with abdominal ultrasound and MRI for evaluation of the pancreas, gallbladder, liver, and spleen. The MRI was superior to CXR in detecting hilar and mediastinal adenopathy and in differentiating nodes from prominent vessels. It was useful in the evaluation of bronchiectasis. The CXR was superior for assessing infiltrates, hyperinflation, sternal bowing, volume loss, and hilar retraction. The MRI was only slightly better than sonography in depicting fatty infiltration of the pancreas. The modalities were equally effective in detecting hepatosplenomegaly and signs of portal hypertension. Gallbladder evaluation was far superior with sonography.

Ovarian vein thrombosis with atypical presentation: role of sonography and duplex Doppler.

Ovarian vein thrombosis was diagnosed in two patients, one postoperatively and one postpartum, with mild, atypical presentations, using sonography and duplex Doppler. Demonstration of the dilated ovarian vein with internal thrombus, without demonstrable flow by Doppler, was diagnostic. We propose that sonography with duplex Doppler be the initial screening examination in at-risk patients with typical or atypical presentations.

Diagnostic imaging in puerperal febrile morbidity.

This retrospective study was conducted to assess the value of imaging in patients with refractory puerperal febrile morbidity. During a 36-month period, 31 patients were referred for ultrasound and/or computed tomography or magnetic resonance imaging because of postpartum fever unresponsive to broad-spectrum antibiotic therapy of at least 72 hours' duration. Hematomas were identified in 11 women. Abscesses were diagnosed in seven patients, ovarian venous thrombosis in two, vesicouterine fistula in one, small-bowel obstruction in one, and a subcutaneous seroma in one. Twenty-one women had endomyometritis, 13 of whom also had other extrauterine abnormalities (abscess in six, hematoma in four, and ovarian venous thrombosis, vesicouterine fistula, and small-bowel obstruction in one each). Retained placental tissue was found in two women with endomyometritis. Only two subjects had negative imaging studies. In most patients, imaging led to definitive diagnosis and specific therapeutic measures resulting in resolution of the febrile morbidity. Our experience suggests that these imaging techniques may be helpful in evaluating puerperal fever.

Cis-platinum (II) diaminedichloride: another cause of bilateral small kidneys.

Cis-platinum (II) diaminedichloride (CPDD) is a new chemotherapeutic agent whose major side effect is renal toxicity. Serial urography may show evidence of a diminution of renal size before there is any clinical evidence of renal failure in patients being treated with CPDD. We recommend that these patients be followed closely with serial radioisotope scanning and/or urography to detect early renal damage.

Relative merits of MRI, transrectal endosonography and CT in diagnosis and staging of carcinoma of prostate.

Magnetic resonance imaging (MRI) and transrectal sonography of 27 patients with biopsy-proved carcinoma of the prostate were performed to compare the sensitivity of these modalities to each other for diagnosis and to computed tomography (CT) for staging. Sonography was superior to MRI for the detection of intraglandular carcinoma and capsular disruption. MRI was superior to both sonography and CT for evaluating seminal vesicle invasion, and slightly better than CT for detecting lymphadenopathy.

Impact of magnetic resonance on staging of renal carcinoma.

Computerized tomography (CT), ultrasound, and angiography have been used for staging renal cell carcinoma. CT has proven to be the most reliable and sensitive of these techniques. Magnetic resonance (MR) has emerged recently as a viable alternative imaging modality. Five patients with renal cell carcinoma and suspected caval involvement were evaluated by CT, ultrasound, and MR. Caval extension and the differentiation of intra-versus retrocaval tumor was seen with greater clarity on MR scans; perinephric extension was seen equally well with both modalities. The primary tumor itself was better defined with CT. In patients with equivocal findings regarding the renal veins or inferior vena cava, MR is a valuable adjunct in preoperative evaluation. In patients at high risk for contrast administration, MR is the staging modality of choice.

Staging of ureteral transitional cell carcinoma by CT and MRI.

Intravenous urography and retrograde pyelography are the primary radiologic studies for detecting ureteral carcinoma but give limited information regarding stage of disease. Computed tomography (CT) and magnetic resonance imaging (MRI) delineate the extent of ureteral carcinomas with a high degree of accuracy by depicting the periureteral fat and presence or absence of lymphadenopathy. In selected cases, CT and MRI are valuable for assessing the presence or absence of tumor in a ureteral stump and for the differential diagnosis of ureteral obstruction. Five cases of ureteral carcinoma and 2 cases of stump carcinoma are presented with preoperative CT and/or MRI evaluation and staging.

The radiology of inflammatory bowel disease.

This article presents various imaging modalities, including plain films, ultrasonography, magnetic resonance imaging, and radionuclide imaging, used for the diagnosis of inflammatory bowel disease (IBD), ulcerative colitis (UC), and Crohn's disease (CD). Also discussed are how to distinguish UC from CD and some of the intestinal complications of IBD.

Rare pancreatic malignancies.

The incidence of pancreatic malignancy in most countries is increasing, and the overall prognosis for nonendocrine pancreatic cancer is grim. The majority of nonendocrine pancreatic malignancies are duct cell adenocarcinomas with no special features. However, several morphologic subtypes have been fairly recently recognized and classified, some of which appear to have a different inherent biologic behavior and a chance for a longer survival after resection. This article describes the rare nonendocrine pancreatic malignancies, emphasizing those clinical, pathologic, and radiologic features that serve to differentiate these entities from the more common duct cell adenocarcinoma of the pancreas.

Evaluation of unaccountable phlebitis with the long arm silastic catheter.

This study was initiated to identify the causal factor responsible for the development of "unaccountable phlebitis" when using the long arm silastic catheter. Use of computerized axial tomography has provided a means of analyzing veins containing indwelling silastic catheters of the upper arm. Physical data of diameters of the veins are limited to inaccuracies of the machine and must only be regarded as relative. We have been able to detect a great variability of cross-sectional vein diameter and area within any one patient. This narrowing tends to occur in the mid-upper arm region and may explain the occurrence of "unaccountable" phlebitis in this area. It appears that laminar blood flow and flotation of the catheter in the vein is inhibited in these areas of narrowing.

Bronchioloalveolar cell carcinoma: impact of histology on dominant CT pattern.

The authors set out to determine how histologic variability in bronchioloalveolar cell carcinoma impacts dominant radiographic patterns shown by computed tomography (CT). Thoracic CT's of all patients with pathologically confirmed bronchioloalveolar cell carcinoma diagnosed over a 36-month period were reviewed without knowledge of underlying histologic type. The dominant CT pattern was recorded as 1) air space consolidation; 2) focal nodule or mass; and 3) multicentric nodules or masses. Nodules and masses were further characterized according to borders, distribution, and associated findings, including spiculations and air bronchograms. Histology was independently reviewed. Twenty-seven patients, 16 women and 11 men, mean age 60 years, were diagnosed with bronchioloalveolar cell carcinoma. In 6 (22%) of the 27 cases, the histology was mucinous, with malignant goblet cells identified. Five (83%) of the six mucinous neoplasms manifested as air space consolidation and three (50%) of the six presented with multiple nodules, in which two had coexisting air space consolidation. Of the remaining 21 cases (78%) with nonmucinous histology, the primary malignant cells of origin included Clara cells (n = 8), tall columnar epithelial cells (n = 7) and alveolar type II pneumocytes (n = 6). Sclerosis was a dominant histologic feature in 14 (67%) of the 21 cases. Seventeen (81%) of the nonmucinous neoplasms presented as isolated nodules or masses and four (19%) presented as multiple nodules or masses. Of these four patients with multifocal disease and nonmucinous histology, multiple bronchioloalveolar adenomas accounted for multicentricity in two of the patients. Significant correlations included air space consolidation with mucinous histology (p = 0.001) and focal nodule or mass with nonmucinous histology (p = 0.001). At CT of bronchioloalveolar cell carcinoma, the patterns of air-space consolidation correlate with mucinous histology and isolated nodules or masses with nonmucinous histology. The pattern of multiple nodules or masses, however, did not correlate with histology. Coexisting bronchioloalveolar adenomas can contribute to apparent multicentric disease in patients with nonmucinous histology.

Imaging-guided percutaneous biopsy of hepatic masses.

Imaging-guided biopsy of hepatic masses has become the standard for diagnosis. This article reviews the computed tomography, ultrasound, and magnetic resonance imaging characteristics of the more common benign and malignant hepatic masses. This is followed by a description of the procedure from preprocedure work-up to postprocedure care, with a discussion of indications, contraindications, complications, and technique.

Viscosity of iodinated contrast agents: significance for peripheral venous injection.

The meglumine salt of a urographic contrast agent is significantly more viscous than the comparable sodium salt. To noninvasively deliver a bolus to some patients it is often necessary to use a 21-gauge needle. The inherent resistance of a 21-gauge scalp needle results in approximately a 60% increase in injection time for the meglumine salt as opposed to the sodium salt.

The fabella sign: fabella displacement in synovial effusion and popliteal fossa masses. Normal and abnormal fabello-femoral and fabello-tibial distances.

Posterior displacement of the fabella is a reliable sign of synovial effusion or mass which may be applied even when inflammation or post-traumatic edema obscures the extrasynovial fat lines of the knee joint. The fabella normally moves posteriorly as the knee is flexed, but correlation of fabella position with degree of flexion defined ranges of normal and abnormal fabella position which are useful in diagnosis. If all lateral views are obtained with the knee flexed over a standard angle bolster, fabella position is standardized and fabella displacement readily detected without need for measurement. With experience, fabella displacement is readily apparent in non-standard positions as well. Normal fabella position does not rule out small effusion or effusion which is confined to the suprapatellar pouch because the knee is extended.

CT angiogram sign: incidence and significance in lobar consolidations evaluated by contrast-enhanced CT.

OBJECTIVE: The CT angiogram sign--that is, the ability to see normal pulmonary vasculature within parenchymal consolidations--was initially reported as specific for the diagnosis of bronchioloalveolar cell carcinoma. Our purpose was to establish the frequency of this sign in lobar consolidations of varied causes as revealed by contrast-enhanced CT. We also sought to determine if the presence of this sign contributed to the specificity of radiographic diagnosis. MATERIALS AND METHODS: All consecutive contrast-enhanced thoracic CT examinations performed for evaluation of lobar consolidations between May 1994 and April 1997 were reviewed. The CT angiogram sign was considered present when segments of pulmonary vessels could be identified within alveolar consolidations. Medical records were reviewed to establish the causes of the consolidations. RESULTS: Fifty-one patients (24 women, mean age = 59 years; 27 men, mean age = 46 years) had lobar or multilobar consolidations due to pneumonia without central obstruction (n = 20), pneumonia or pneumonitis with central obstruction (n = 19), passive atelectasis (n = 7), and (one case each) mucus plugging, lipoid pneumonia, pulmonary lymphoma, bronchioloalveolar cell carcinoma, and pulmonary hemorrhage. The CT angiogram sign was present in 15 (29%) of 51 consolidations, including seven (37%) of 19 postobstructive consolidations, four (20%) of 20 cases of pneumonia without central obstruction, one (14%) of seven cases of passive atelectasis, and each single case of lymphoma, bronchioloalveolar cell carcinoma, and lipoid pneumonia. CONCLUSION: The CT angiogram sign is a common finding in lobar consolidations evaluated by contrast-enhanced CT. However, the sign does not add specificity to the radiographic diagnosis.

A complicated case of aortoduodenal fistula.

Aortoduodenal fistula may occur primarily as a complication of abdominal aortic aneurysm or secondarily after reconstructive surgery of the abdominal aorta. The clinical presentation may be occult, with the classic triad of mass, pain, and bleeding inapparent or overshadowed by signs of infection. A high index of clinical suspicion combined with radiographic and endoscopic examinations will establish the diagnosis.

Mucocele of the appendix and pseudomyxoma peritonei.

Mucocele of the appendix is a descriptive term for an abnormal mucous accumulation distending the appendiceal lumen. Pseudomyxoma peritonei is characterized by mucinous ascites and implants throughout the abdominal cavity. Thirty-four cases of appendiceal mucocele and seven cases of pseudomyxoma peritonei of appendiceal origin on file at the Armed Forces Institute of Pathology were reviewed for their clinical, pathologic, and radiologic findings. These cases provided examples of the major radiologic findings reported in this entity. Previously unreported findings of dependent echoes within some mucoceles on sonography and pseudomyxoma peritonei tracking along the umbilical vein remnant or mimicking an intrahepatic mass are presented.