Subcutaneous splenosis.

Splenosis is the ectopic implantation of splenic tissue, usually as the result of trauma. Intraperitoneal, intrathoracic, and retroperitoneal sites of implantation have been reported. The authors report a case of subcutaneous splenosis involving the abdominal wall that was imaged with CT and scintigraphy.

Successful methylphenidate treatment of apathy after subcortical infarcts.

A patient with prominent apathy secondary to multiple subcortical infarcts was treated successfully with methylphenidate. SPECT and reaction time testing showed selective improvement of frontal system function, consistent with a recent model of frontal-subcortical circuits and behavior.

Positive captopril renal scintigraphy in a patient with extensive bilateral renal interlobar arterial disease.

The authors determined an unusual cause of renovascular hypertension in a 29-year-old man with the recent onset of hypertension and a history of intravenous substance abuse. Captopril renal scintigraphy (CRS) demonstrated bilateral renogram changes and a decrease in estimated global glomerular filtration rate. The abdominal aortogram failed to show renal artery or branch artery stenosis. Magnified selective views of the kidneys demonstrated extensive, bilateral, small vessel interlobar disease. Two major points are illustrated in this patient. First, in the presence of positive CRS results and a history of renovascular hypertension, bilateral, selective, magnified renal angiography should be performed in accordance with standard abdominal aortic views when large vessel disease is not detected. Second, although surgical intervention is not an option in such patients, finding the cause of hypertension is important for patient management.

Rare solitary metastasis to subcutaneous tissue from choriocarcinoma of testis.

A rare case of solitary metastasis to subcutaneous tissue from choriocarcinoma of the testis which was predominantly seminoma is reported. The propensity for vascular route of metastasis of this tumor type producing the patient's clinical picture is presented. The human beta chorionic gonadotropin tumor marker elevation to 4,200 units preoperatively fell to normal two weeks postoperatively, suggesting a solitary metastatic site with total tumor extirpation. Nevertheless, it seemed prudent to give chemotherapy because the nature of the metastatic route suggested other microscopic sites of metastasis. The prognosis of this highly malignant neoplasm, while poorest of the array of testis tumors, has improved dramatically with the advent of effective chemotherapy.

Congenital nephrotic syndrome. Gallium-67 imaging.

Congenital nephrotic syndrome is a rare disorder. Heavy proteinuria, hypoalbuminemia, and edema occur during the first 3 months of life. Initial cases were reported from Finland and sporadic cases have occurred elsewhere. Finnish cases demonstrated an autosomal recessive inheritance pattern; currently, Finnish and non-Finnish types are recognized. The clinical course consists of failure to thrive, frequent infections, declining renal function, and early death by age 4 years from sepsis or uremia. Recently renal transplantation has improved the prognosis of patients with this disease. An abnormal Ga-67 scan in a case of congenital nephrotic syndrome is presented.

Diuretic radionuclide localization of upper urinary tract obstruction.

In 59 children with proved upper urinary tract obstruction diuretic radionuclide ureteral scans provided an accurate assessment of ureteral dilatation sufficient to distinguish ureteropelvic from ureterovesical obstruction. As a result, this test may be used instead of more invasive studies, such as retrograde or antegrade pyelography, to determine the site of obstruction in many cases of hydronephrosis.