Computed tomography of peripancreatic fat planes.

Obliteration of peripancreatic fat planes usually is considered an indicator of peripancreatic tumour infiltration in the presence of a malignant mass, or of inflammation of peripancreatic tissues in patients with pancreatitis. However, absence of peripancreatic fat planes also may be found in patients without evidence of pancreatic disease. Hence, CT scans of 125 patients without clinical or computed tomographic evidence of pancreatic disease were evaluated to assess normal variations in the anatomy of the pancreas and its relation to surrounding vessels and bowel loops. The fat plane separating the superior mesenteric artery from the pancreas was preserved in 100% of patients. Conversely, fat planes between the pancreas and the superior mesenteric vein, inferior vena cava, and adjacent bowel loops were partially or totally obliterated in 13% to 50% of patients. It is concluded that the absence of fat around the superior mesenteric artery is highly suggestive of pathologic changes of the pancreas, while the lack of fat planes between the pancreas and other splanchnic vessels or bowel loops frequently is normal, and therefore, is an unreliable sign of pancreatic disease. The applications of these findings to the assessment of tumour resectability by CT, and to CT scanning techniques, are discussed.

Unchanged size of a dilated common bile duct after a fatty meal: results and significance.

Sonographic measurement of common bile duct caliber alone is insufficient to ascertain the presence of obstruction. Fatty meal stimulation significantly improves diagnostic accuracy. An increase in caliber of a normal or slightly dilated common duct after the subject has ingested a fatty meal is a strong indicator of biliary obstruction, while a decrease in caliber indicates normal dynamics and virtually excludes obstruction. This study determines the significance of no change in the caliber of the dilated common bile duct of subjects who have eaten a fatty meal. Further imaging studies and clinical/laboratory follow-up of 31 patients showed that in 84% of the cases no obstruction was present. A dilated common duct that does not decrease in size after a fatty meal is not a specific indicator of obstruction. The use of invasive diagnostic procedures in these patients is not advised unless there is other evidence of biliary obstruction.

Necrotic carcinoma of the colon.

The radiological appearances of necrotic colonic neoplasms have been described previously and their bad prognosis has been stressed. Four cases of carcinoma of the colon which exhibited characteristic radiological features are described. Survival following surgery in these cases was extremely variable.

Patterns of breast skin thickness In normal mammograms.

Measurement of the mammographic skin thickness over different parts of the breast was performed in 150 normal patients. The patients were divided into three groups based on breast size and the skin thickness in these three groups compared. The results showed that skin thickness decreased with increasing breast size and that the upper limit of normal was greater than the previously quoted normal range at 3.0 mm. Measurement over different parts of the breast showed that medial exceeded lateral skin thickness by up to 100%, and similarly for the inferior and superior measurements. These findings in the normal breast are of importance in deciding on the presence or absence of abnormal skin thickening as an indicator of underlying breast disease.

The value of modern non-invasive imaging techniques in the elderly.

Computerized tomography, isotope imaging and ultrasonography are available for the investigation of elderly patients at the Middlesex Hospital. Over a six-month period there were 360 acute admissions to the Geriatric Department and 100 specialist imaging techniques were used in their investigation. The pattern of presentation of these patients and results of specialist techniques are presented. Sick elderly patients should have ready access to modern non-invasive imaging techniques.

Real-time breast sonography: application in 300 consecutive patients.

Sonography, disappointing as a primary screening method, has emerged as the single most helpful adjunct to mammography in evaluation of the clinically and/or mammographically abnormal breast. Sonography can reliably diagnose simple cysts presenting as palpable masses or as indeterminate, nonpalpable lesions on mammography. However, differentiation of benign from malignant solid masses cannot be reliably accomplished by sonography. The expense of an automated breast sonographic scanner has deterred many radiologists from the purchase of such a unit. The authors have used both an automated breast scanner and a real-time 10-MHz hand-held unit. This paper describes their experience with the real-time unit, demonstrating both normal and pathologic anatomy. Special emphasis has been placed on the sonographic diagnosis of a simple cyst because this lesion was the cause of one-quarter of all palpable masses and nonpalpable, mammographically dominant masses. Cysts are sharply marginated and anechoic. Posterior enhancement visible in 78 of 80 cysts was not demonstrable on all images in 25% of cysts.

The value of parotid sialography.

One hundred consecutive parotid sialograms were reviewed to assess the clinical usefulness of the technique. In 54 per cent of patients significant information was provided by the sialogram, and in 22 per cent the diagnosis was made on sialographic appearances alone or the findings altered subsequent management. The highest proportion of useful investigations was found in those presenting with bilateral parotid swelling. No significant information was obtained in patients with an isolated lump in the parotid region.

Ileal disease associated with spinal irradiation for ankylosing spondylitis.

A case of ileitis, clinically resembling regional enteritis, but almost certainly due to previous spinal irradiation for ankylosing spondylitis is described.

Percutaneous drainage access: a simplified coaxial technique.

We describe an access technique that we have used in 150 nephrostomy and biliary drainage procedures and for access to some abscesses and viscera. The system provides safe coaxial access with a 22-gauge removable hub needle, which then acts as a guide wire and is replaced by an 18-gauge cannula. A major advantage is that only one guide wire is used (0.038-inch) for the entire drainage procedure. No significant complications have occurred to date with this method.