Colonic transit in spinal cord-injured patients.

This report describes a study of transit time through the colon, as well as the caliber of the colon and distal small bowel, in 28 spinal cord-injured patients to see if there is a correlation between those findings and difficulty with bowel care and symptoms. In 15 of these 28 patients anorectal dynamic studies were also done. Each patient ingested 20 radiopaque markers, after which colon transit times were measured by multiple abdominal radiographs. The width of the ileum was measured and correlated with symptoms. The findings indicate that transit time was delayed in the left and rectosigmoid colon; four patients had a large and highly compliant rectum, whereas six had anorectal dyssynergia. All ten had difficulty with bowel care. The distal small bowel was dilated in ten patients, all of whom had symptoms and nine of whom had spinal cord lesions superior to T5.

Acute sinusitis mimicking antrochoanal polyp.

Three cases of antral sinusitis that presented in an unusual fashion are reported. In each case, the inflamed, swollen sinus mucosa became redundant and prolapsed into the nasal cavity through a widened sinus ostium, mimicking the findings of an antrochoanal polyp. The cases represent the first report in the radiographic literature of this unusual manifestation of maxillary sinusitis.

Esophagography and esophagoscopy. Comparison in the examination of patients with head and neck carcinoma.

We carried out a prospective, double-blind study at three institutions, comparing esophagography with esophagoscopy for the detection of simultaneous cancer of the esophagus in patients with other squamous cell cancers of the head and neck. The goal was to determine whether esophagography and esophagoscopy are necessary for the examination of patients before treatment. One hundred eighty-two patients were studied; both examinations were done in 148 patients. Twenty-one patients could not undergo esophagoscopy; esophagography was inadequate in 9 patients; 4 patients could have neither examination. Concordance was noted between the two procedures in 86.5% of patients. Sixty-five percent were normal, and 21.5% were abnormal. One esophageal cancer was found in this series that was diagnosed by both methods. Our data suggest that esophagoscopy and esophagography may be complementary in evaluating squamous cell carcinoma of the head and neck in patients before treatment. Esophagography alone was useful in patients in whom esophagoscopy could not be performed.

Mesenteric cyst with atypical computed tomography appearance.

A case of mesenteric chylous cyst containing an unusual fluid-fluid level demonstrated on computed tomography but not on ultrasonography is presented.

Imaging the patient with right upper quadrant pain.

A variety of high-resolution imaging techniques are currently available for the evaluation of patients with RUQ pain. In these patients, an imaging approach that is based on identifying the presence of certain clinical signs and symptoms can aid in choosing the appropriate imaging modality and establishing the diagnosis. For patients presenting with a positive Murphy sign, sonography and biliary scintigraphy are the most useful initial imaging techniques. In patients with fever and a negative Murphy sign, a combination of sonography and contrast-enhanced CT can establish the diagnosis in most cases. And finally, in patients without fever or a positive Murphy sign, CT and MR are appropriate first-line imaging techniques.

The role of bone scan and radiography in the diagnostic evaluation of suspected pedal osteomyelitis.

The authors reviewed the three-phase bone scans and radiographs of 24 patients with suspected pedal osteomyelitis who also had histologic confirmation of the diagnosis. Twenty patients had a pedal ulcer, cellulitis, or necrosis. Sensitivity and specificity of bone scanning were 70% and 43% respectively. Sensitivity and specificity of radiography were 70% and 50% respectively. The non-invasive diagnosis of pedal osteomyelitis remains problematic due to the poor specificity of bone scans and radiographs.

Computed tomography of ilio-psoas muscle tumors.

A retrospective evaluation of computed tomographic scans done at our institution showing psoas muscle tumors is presented. The anatomy of the psoas muscle along with a discussion of normal psoas anatomy which can be mistaken for tumor are reviewed. Primary muscle tumors along with metastatic, neurogenic, and lymphomatous tumors affecting the psoas muscle is discussed. The use of computed tomography for assessment of extent, origin, and structure of psoas muscle tumors is demonstrated.

Bladder infarct.

We present here a case of a bladder infarct as a complication of aortofemoral bypass surgery. An intravenous urogram 6 weeks after surgery showed reduced expansion on the left side of the bladder and a sausage-shaped filling defect at the site of the infarct. The diagnosis was made by histologic examination of bladder wall biopsies.

Unusual fistulae between the rectum and the lower urinary tract: simple techniques for diagnosis.

This paper presents two unusual fistulae between the rectum and the lower urinary tract in adults, one a posttraumatic fistula following dilatation of a sigmoid colon stricture and the other a congenital anomaly. In both cases a contrast enema was negative; in one case a voiding cystourethrogram was negative. The fistula was demonstrated in case 1 by repeating the enema and having the patient raise his intraabdominal pressure, and in case 2 by having the patient hold while attempting to pass flatus during a cystogram, which demonstrated gas bubbles entering the bladder.

Leiomyoma of the testis: sonographic and pathologic findings.

This is the first report of an intratesticular leiomyoma. On ultrasonography the lesion was hypoechoic, indistinguishable from a malignant testicular neoplasm, but similar in appearance to other leiomyomas occurring elsewhere in the body.

Obliterative pyelitis.

A patient with severe undiagnosed and untreated pyelitis developed mural masses in the renal pelvis and in the infundibulum of the upper pole calyx. The masses were presumed to be inflammatory. The patient developed a severe stricture of the renal pelvis and complete occlusion of the upper pole calyx. This is an example of obliterative pyelitis, as described in the era before antibiotics were available.

Functional abnormalities of the gastrointestinal tract in patients with spinal cord injuries: evaluation with imaging procedures.

One quarter of patients with spinal cord injuries eventually have severe chronic gastrointestinal symptoms. Because there are about 1.5 million such patients in the United States, major chronic gastrointestinal symptoms will develop in approximately 400,000 patients, all of whom are likely to need the services of radiologists. These gastrointestinal abnormalities, however, are quite different from the gastrointestinal problems that occur in the general population. For this reason, the imaging methods used for diagnosis in these patients are also different from those used with persons who do not have spinal cord injuries. The purpose of this review is to describe the role of diagnostic imaging in patients with severe chronic gastrointestinal symptoms associated with spinal cord injury.

Urinary bladder pseudolesions on contrast-enhanced helical CT: frequency and clinical implications.

OBJECTIVE: The goals of this study were to define the distinguishing characteristics and frequency of urinary bladder pseudolesions that are produced as opacified urine enters the bladder during contrast-enhanced helical CT of the abdomen and to evaluate the usefulness of delayed imaging in differentiating pseudolesions from true lesions. SUBJECTS AND METHODS: Contrast-enhanced routine CT scans of 184 patients were obtained prospectively. For each patient, we also obtained 5-min delayed images of the bladder. The images were evaluated for apparent focal thickening or polypoid lesions involving the bladder wall, findings that may represent bladder neoplasia, without knowledge of the indications for the scan, the patient's clinical history, or the patient's diagnosis. Apparent lesions that were visible on routine images and entirely absent on delayed images were considered to be pseudolesions. RESULTS: Apparent lesions were identified on 20 (10.9%+/-4.5% [limits of the 95% confidence interval]) of the routine CT scans. Using delayed images, the 21 apparent lesions in these 20 patients were resolved as 13 pseudolesions and eight true lesions. Pseudolesions were present in 6.5%+/-3.6% of patients. CONCLUSION: Pseudolesions of the bladder that are indistinguishable from true lesions pose a significant clinical problem in routine contrast-enhanced helical CT of the abdomen. Delayed imaging of the bladder is useful in distinguishing pseudolesions from true lesions.

Inferior mesenteric artery aneurysm: demonstration by computed tomography.

Inferior mesenteric artery aneurysms are very rare vascular lesions. A case of isolated inferior mesenteric artery aneurysm diagnosed by computed tomography is reported.

Efficacy of rehabilitative management of dysphagia.

Efficacy of treatment for dysphagia in medically stable patients was defined as a reduction in the occurrence of aspiration pneumonia. Aspiration pneumonia was diagnosed by radiographic and/or laboratory analysis and was identified by retrospective chart review. Two groups of treated patients (48 without and 13 with a history of aspiration pneumonia) were compared to a group of untreated patients. There were no statistically significant differences in the occurrence of aspiration pneumonia in the treated groups, but both treated groups were subject to significantly less aspiration pneumonia than the untreated group. Measures of severity indicated that even mildly dysphagic patients were at risk for the development of aspiration pneumonia, and even severely dysphagic patients responded to rehabilitative management of their swallowing problems. Efficacy of treating swallowing was demonstrated, and a general outcome criterion for treatment was proposed.

Imaging the effects of an ectopic spleen on the urinary tract.

A 75-year-old woman with chronic lymphocytic leukemia who presented clinically with urinary frequency was found on physical examination to have a pelvic mass. Ultrasound and computed tomography showed it to be due to a large ectopic spleen lying in the pelvis behind the bladder and compressing it anteriorly. The spleen became smaller and the symptoms regressed with chemotherapy. We review the features of an ectopic spleen as seen on diagnostic imaging studies.

Polypoid Menetrier's disease associated with acromegaly.

There are two forms of Menetrier's disease. The common form involves thickened gastric rugae, while the rare form involves discrete gastric polyps. The clinical literature suggests an association between Menetrier's disease and acromegaly, as well as other neuroendocrine neoplasms; the radiological literature has not addressed the issue. We describe a patient with acromegaly who developed the rare polypoidal form of Menetrier's disease.

Computed tomography of the iliopsoas muscle.

Computed tomography (CT) is an ideal method for the imaging of the psoas muscle. The authors present 13 cases of patients with psoas abnormalities diagnosed by CT. The CT features of the different pathologic entities and comparison of CT with other imaging modalities are discussed.

Dual-phase helical CT of locally invasive pancreatic adenocarcinoma.

Dual-phase helical CT permits imaging of the pancreas and the peripancreatic structures in the arterial dominant and portal venous phases of enhancement, providing information crucial in the assessment of the local extent of pancreatic adenocarcinoma. This essay reviews the dual-phase helical CT findings of local extension that preclude potentially curative surgery, including vascular involvement, ligamentous or mesenteric invasion, extension of the tumor to involve the stomach or duodenum, and invasion of adjacent solid organs.

Esophageal wall thickening: a CT finding in diffuse esophageal spasm.

We report three patients with esophageal wall thickening, incidentally found at CT, in whom further evaluation led to the diagnosis of diffuse esophageal spasm (DES). All cases showed smooth, symmetric, circumferential wall thickening of the distal two-thirds of the esophagus with normal periesophageal fat. No lung parenchymal abnormalities suggestive of aspiration were seen. DES, although uncommon, is another benign condition that should be included in the differential diagnosis of esophageal wall thickening detected by CT.