CT in iatrogenic cerebral air embolism.

Three patients with suspected iatrogenic cerebral air embolism had cranial CTs performed within 24 hr of onset of symptoms. One was interpreted as normal, one showed a large, right frontoparietal enhancing lesion, and the third showed evidence of bi-thalamic infarction. Follow-up scans 7 to 10 days later showed either single or multiple enhancing infarcts in all patients. Although CT proved a valuable tool in the diagnosis of this condition, one out of three initial studies were negative, necessitating a follow-up scan.

Forensic radiology.

Like any branch of medicine, radiology has an interface with the law. This has two main facets: first the technical applications of radiology to forensic problems and secondly the legal aspects of radiological practice.

Impending catheter perforation of superior vena cava: radiographic recognition.

In six of nine patients with superior vena caval perforation by a central venous catheter, the chest radiograph showed a gentle curve at the tip of the catheter 4 hr to 7 days before clinical or radiographic recognition of perforation. This radiographic sign should prompt catheter repositioning to avoid the morbidity and potential mortality associated with superior vena caval perforation.

The radiologic assessment of iatrogenic urethral injury.

Iatrogenic urethral injury producing urethral stricture results from urethral instrumentation, bladder catheterisation and, rarely, as a result of abdomino-perineal resection for carcinoma of the rectum. We here record our experience with iatrogenic urethral strictures and correlate the site of urethral stricture with its etiology. Because our hospital is a referral centre for urethral disease our results indicate that iatrogenic urethral injury (40%) is more common than previously described. They also indicate that urethral stricture due to instrumentation is more common in the bulbomembranous urethra (approximately 80%) and that stricture due to catheterisation is more common at the penoscrotal junction (approximately 70%). Instrument strictures are usually short and well defined. Catheter strictures are generally long and irregular, commonly being associated with visualisation of the glands of Littre.

Experience with single photon emission computerized tomography (SPECT) in follow-up of sternotomy healing.

Single photon emission computerized tomography (SPECT) was performed thrice in ten patients undergoing open-heart surgery--preoperatively and 2 and 12 weeks postoperatively. The operations were done for ischemic heart disease (5), aortic valvular stenosis (2), aortic valvular insufficiency (1), leaking mitral prosthetic valve (1) and combined aortic and mitral valvular stenosis and insufficiency (1). The healing process in the longitudinally divided sternum was evaluated from the SPECT study. Four conventional static images in two dimensions were registered in anteroposterior, posteroanterior and left and right lateral projections. A tomographic study was done. Quantitative analyses were performed. The ratio of the sternal counts to the counts from a thoracic vertebra was calculated for use as a reference. The activity ratios showed a similar pattern in six cases, with initial increases and at 12 weeks slight decrease compared with the preoperative values. In two cases the activity was still increasing after 12 postoperative weeks. One patient, with sternotomy also one year previously, showed only slightly increased activity. The activity at the areas of the sternal wires was increased in six cases. The study thus revealed differing patterns of isotope uptake, although recovery was uneventful in all patients. The differences may reflect the possibility that the operative course and the preoperative clinical status can influence the healing mechanisms.

Benign iatrogenic cause of mediastinal gas seen on computed tomography.

Following intravenous administration of contrast material, intravenous gas was trapped by a mediastinal mass obstructing the superior vena cava (SVC). The computed tomographic demonstration of gas in the region of a mediastinal mass producing SVC obstruction is presented.

CT features of iatrogenic hepatic arterioportal fistulae.

Peripheral arterioportal fistulae are a relatively frequent complication of hepatic biopsies and transhepatic catheterizations. Three cases were revealed by dynamic computed tomography (CT) and confirmed by angiography. The morphologic and densitometric characteristics of these arteriovenous fistulae on CT in most cases indicate the causal mechanism and eliminate consideration of tumor.

[Intra-abdominal foreign bodies following laparotomy interventions: report of a case]. / Il problema dei corpi estranei endoaddominali dopo intervento laparotomico: considerazioni su un caso.

The authors report their own observation of a case of post-laparotomic endoabdominal foreign body, which for a long period had remained asymptomatic. Starting from the clinical case, they effect a short study of such iatrogenic pathology, and state the diagnostic and therapeutic criteria thereabout. They subsequently dissertate on the possible preventing means.

Iatrogenic esophageal-pleural fistula: subtlety of diagnosis in the absence of mediastinitis.

Seven patients with iatrogenic esophageal-pleural fistulas are described, and the differences in radiographic and physical findings in these patients and in patients with esophageal perforation with mediastinitis are emphasized. Radiographic findings in patients with esophageal pleural fistulas are pneumothorax, hydropneumothorax and localized pneumonitis. These fistulas can mimic other inflammatory supradiaphragmatic or infradiaphragmatic processes. Clinical and radiographic signs may be subtle, and active investigation is needed to establish the diagnosis of esophageal-pleural fistula in patients who have undergone esophageal manipulation.

Computed tomography of iatrogenic hepatic lesions following percutaneous transhepatic cholangiography and portography.

Computed tomography (CT) was performed after percutaneous transhepatic cholangiography (PTC) in 22 patients and after percutaneous transhepatic portography (PTP) in 10 patients in order to find possible iatrogenic hepatic lesions. The interval between the transhepatic examinations and CT was usually less than 10 days. Hepatic lesions of low attenuation were demonstrated in four patients following PTC and in four patients following PTP. In one patient, bile leakage following PTC and transhepatic bile duct intubation necessitated laparotomy. In all other patients, the complications were considered clinically insignificant.

Pneumomediastinum after double-contrast barium enema examination: a sign of colonic perforation.

Pneumomediastinum as an iatrogenic complication of a diagnostic procedure is rare [1-7]. We report a case of pneumomediastinum following a double-contrast barium enema examination. With the increasing use of double-contrast barium studies, pneumomediastinum may be an important sign of rupture of the colon during this examination.

Iatrogenic arteriovenous fistula in a cynomolgus macaque (Macaca fascicularis): a case report.

A juvenile male cynomolgus macaque was slightly depressed and had a rough haircoat. Cardiomegaly and pulmonary interstitial edema were found. A distinct fremitus was palpable over the right femoral canal. The only abnormal laboratory finding was an elevated total leukocyte count. A femoral arteriogram confirmed the diagnosis of femoral arteriovenous fistula. Surgical correction of the fistula was successful in reversing the heart failure. The history and anatomic location of the lesion suggested an iatrogenic cause.

False-positive lung imaging: inadvertent injection into a pulmonary artery catheter.

A case of a ventilation-perfusion mismatch seen post-operatively in a patient with chest pain is reported. There was absence of perfusion to the right lung, with relatively normal ventilation. The study was initially interpreted as indicating a high probability of pulmonary embolus. It was then discovered that the injection had been inadvertently made into a Swan-Ganz catheter, with its tip in the left main pulmonary artery. The mismatch was therefore iatrogenic and not related to pulmonary embolus. The false-positive lung imaging which resulted has not been previously reported in the literature.