Multiple hepatic abscesses due to Yersinia enterocolitica.

We report a case of multiple hepatic abscesses due to Yersinia enterocolitica in a 58 yr old male. This case is typical of the other 39 cases reported in the literature in that the patient had alcoholism, malnutrition, iron overload and a subsequently diagnosed malignancy. Ultrasound showed multiple hypoechoic areas in the liver which were confirmed by CT scan. The patient also had a rectal lesion initially thought to be malignant, leading to a presumptive diagnosis of metastatic disease. A CT-guided fine needle aspiration biopsy of a liver lesion unexpectedly revealed pus which subsequently grew Yersinia enterocolitica. The organism was also isolated from the patient's blood and feces. This case illustrates the need for histological microbiological investigation of radiologically diagnosed presumptive malignancy.

Two-tone pancreas on T1-weighted images: correlation with abnormalities on magnetic resonance pancreatography.

Two patients are presented in whom geographical alteration in signal between areas of normal and abnormal pancreatic tissue on T1-weighted magnetic resonance images of the pancreas was observed. This alteration in signal intensity produced a 'two-tone' pattern; magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) in both patients revealed altered pancreatic duct drainage. It is believed that the 'two-tone' pancreas effect on T1-weighted images of the abdomen, may indicate aberrant duct drainage and that MRCP is an ideal means of further evaluation.

Prevertebral soft-tissue measurements in cervical spine injury.

To clarify normal values for cervical prevertebral soft-tissue measurements and evaluate when they are useful as a marker of cervical spine injury, the prevertebral soft-tissue measurements of 79 control and 57 acutely injured patients were retrospectively compared by two independent observers. The second, blinded, observer made a provisional diagnosis and indicated if increased soft-tissue measurements had assisted in making a diagnosis of injury. If measurements > 7 mm at C2/3 and > 21 mm at C6/7 were considered abnormal, a true positive rate of 53% and false positive rate of 5% were observed. The differences between the mean measurements in the control and injured groups were statistically significant (P < 0.0001 at C2/3 and P < 0.01 at C6). Soft-tissue measurement improved the diagnostic confidence of the blinded second reviewer in 17.5% of the injured group. Analysis of this subgroup revealed a 50% error rate in initial reporting. In all of these cases, the abnormal soft-tissues had been ignored prospectively Routine measurement of the prevertebral soft tissues is a simple procedure that may provide an important due to subtle cervical spine injury.

"Spinolaminar breach": an important sign in cervical spinous process fractures.

OBJECTIVE: To report the sign of "spinolaminar breach" and its likely importance in fractures of the cervical spinous processes. DESIGN: Six cases of spinous process fractures demonstrating disruption of the spinolaminar line or "spinolaminar breach" were analyzed. Lateral and anteroposterior radiographs (n=6), CT scans (n=3) and MRI scans (n=1) were reviewed together by the authors, with consensus being reached as to the radiographic findings. Clinical records were also reviewed. RESULTS: The levels of injury were C6 (n=5) and C5 (n=2). Injuries were associated with delayed anterior subluxation (n=4) and neurological deficit (n=2). Five patients were male and one was female with a mean age of 31 years (range 8-59 years). Injuries resulted from motor vehicle accidents (n=4), a motor cycle accident (n=1) and a fall (n=1). CONCLUSION: "Spinolaminar breach", or disruption of the spinolaminar line, indicates a complex spinous process fracture with extension into the lamina and spinal canal. Spinous process fractures with spinolaminar breach may have associated posterior ligamentous injury with potential for delayed instability and neurological deficit. It is important that radiologists and physicians caring for the trauma patient be aware of this sign in order to avoid misdiagnosis as a "clay shoveler's fracture", which can lead to adverse outcome.

Magnetic resonance cholangiopancreatography following liver transplantation.

The magnetic resonance cholangiopancreatography (MRCP) findings following all three forms of biliary anastomosis and some of the common biliary complications following liver transplantation have been demonstrated. The ability of this technique to image the biliary tree non-invasively in this group of immunocompromised patients should represent a substantial advantage over other forms of direct imaging such as endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiopancreatography. This form of imaging is particularly useful when a T-tube is not in place and may provide unique information not obtainable by traditional methods of direct imaging. In addition, MRCP should improve planning of biliary intervention.

Respiratory viral infections in lung transplant recipients: radiologic findings with clinical correlation.

PURPOSE: To evaluate radiologic finding of respiratory viral infection in lung transplant recipients with clinical correlation. MATERIALS AND METHODS: Over 5 years, 21 episodes of respiratory viral infection (parainfluenza [n = 9], respiratory syncytial virus [n = 8], adenovirus [n = 5], influenza [n = 2]) were diagnosed 6-727 days (mean, 270 days) after lung transplantation in 20 recipients. Chest radiographs, computed tomographic (CT) images, and clinical records were reviewed. RESULTS: Sixteen episodes of respiratory viral infection were diagnosed in patients with symptoms of lower respiratory tract infection or acute allograft dysfunction; five were diagnosed in asymptomatic patients. Chest radiographs were abnormal in 11 (52%) episodes; findings included heterogeneous or homogeneous opacities and masslike consolidation. All patients with radiographic abnormalities were symptomatic. Chest radiographs were unchanged from baseline in 10 (48%) episodes; in one, CT revealed findings not depicted at radiography. Adenoviral infection (n = 5) was typically symptomatic, was associated with new radiographic abnormalities, and was rapidly lethal (n = 4). Infection with parainfluenza and/or respiratory syncytial virus was commonly asymptomatic and was not associated with radiographic abnormalities; affected patients had good outcomes. CONCLUSION: Respiratory viral infections are important causes of morbidity and mortality in lung transplant recipients. Radiographic abnormalities in patients with respiratory viral infections were usually accompanied by symptoms of lower respiratory tract infection. Adenoviral infection was frequently accompanied by progressive pulmonary opacity and fatal outcome.