Chordae tendineae rupture resulting in pulmonary edema in a patient with discrete subvalvular aortic stenosis--a case report and literature review.

This report concerns an apparently healthy elderly woman who presented with gradually worsening mitral regurgitation secondary to chordae tendineae rupture leading to pulmonary edema in the presence of discrete subvalvular aortic stenosis with a severe gradient reflecting the left ventricular outflow tract obstruction. The gradual worsening of heart failure took place parallel to the increase in severity of mitral regurgitation in a short period. The patient underwent successful mitral valve replacement with myectomy. Surgical inspection revealed rupture of the chordae tendineae to the posterior leaflets without any significant primary intrinsic disease of the mitral valve. The predominant mechanism of chordae tendineae rupture in this patient with discrete subvalvular aortic stenosis is a severe pressure gradient. It is suggested that increased awareness of chordae tendineae rupture as a cause of mitral regurgitation and the prompt use of appropriate diagnostic tools may facilitate the timely recognition of this potentially fatal, but treatable, cause of mitral regurgitation in patients with left ventricular outflow tract obstruction.

[Computed tomography in the diagnosis of popliteal artery entrapment syndrome].

Popliteal artery entrapment syndrome (PAES), a rare cause of lower limb ischemia, is due to an anomalous relationship between the popliteal artery and the gastrocnemius muscle in the popliteal fossa. Hypertrophy of the muscle, or its anomalous insertion, can displace or compress the artery, leading to stenosis or obstruction. It is clinically manifested by intermittent claudication and most often occurs in young, healthy men. Arteriography is the method of choice to demonstrate vascular lesions, but it can only visualize change in the course of vessels or intrinsic lesions. Due to its high spatial and density resolution, CT scan can differentiate between bony structures, vessels, muscles, and fatty tissue in the popliteal fossa. It is therefore a very useful supporting examination in PAES and can demonstrate whether or not stenosis or occlusion of the artery results from causes outside the artery itself.

[Breast biopsy of nonpalpable lesions after mammography-guided wire localization].

Mammography is used increasingly for diagnosis and screening. Its advantage is its ability to discover very small and often nonpalpable mammary lesions. While its sensitivity in detecting pathological changes in the breast is high, differentiation between benign and malignant lesions is less precise, so biopsy is necessary. To ensure removal of the entire lesion with minimal damage to breast tissue, precise localization is mandatory. The accepted technique is the needle-wire method. 39 of 167 biopsies guided by mammography performed during 3 years for nonpalpable lesions detected by mammography were malignant. In 24 of them the histological diagnosis was atypical epithelial proliferation, considered a transition to carcinoma.

Palmar hyperhidrosis CT guided chemical percutaneous thoracic sympathectomy.

Palmar hyperhidrosis or excessive sweating of the hands causes, to those affected, emotional and physical disturbance and impediment in professional and social life. The cause is unknown. Sweat glands are innervated by the sympathetic chain of the autonomous nervous system. The center of sympathetic regulation of the upper extremities is located between the segments of D.2-D.9 of the spinal cord. Accepted treatment consists of surgery aimed to excise the third thoracic sympathetic ganglion. Besides the surgical procedure as such, and its complications, there are complications inherent to the excision of the ganglion. These are Horner's syndrome, compensatory sweating in other parts of the body, and recurrence of sweating. CT guided chemical percutaneous thoracic sympathectomy presents an alternative, which in the event of failure does not prevent ensuing surgery. The preliminary experience with this procedure in 50 patients is presented and discussed.

Invasive lobular carcinoma. Mammographic pattern.

A retrospective study was done on 107 histologically proven cases of invasive lobular carcinoma which represent about 11.5% of the total of 934 cases of cancer of the breast. Age, breast parenchyma pattern and morphology, and radiological signs of malignancy were tabulated and correlated with the same data in ductal carcinoma. The number of false negative cases was almost twice as high as in ductal carcinoma type (19% versus 10%). In the majority of cases the patients presented a glandular or dense type of parenchyma pattern, which reduced the internal visibility. Besides spiculated masses, relatively subtle signs of malignancy, as asymmetric density and architectural distortion were relatively more frequently represented than in the ductal type of breast carcinoma. No clear-cut radiological criteria could be found pointing toward the underlying histology. Discreet clinical signs in younger patients with glandular or dense breast should alert the radiologist to the possible presence of this type of carcinoma. Due attention should be warranted to these less conspicuous signs of malignancy such as asymmetric density and architectural distortion.

Retroperitoneal-pericardial fistula caused by a perinephric abscess.

A case of a perinephric abscess complicated by a fistulous tract leading to the pericardium is presented. We report herein on the conventional radiological findings.

Nonocclusive ischaemic bowel disease in patients on chronic haemodialysis.

Six patients with chronic renal failure on longstanding haemodialysis are presented, in whom nonocclusive bowel ischaemia occurred as a rare complication of their underlying disorder. Factors implicated in the development of bowel ischaemia in these patients are chronic constipation resulting in increased intraluminal pressure on the bowel wall, premature and progressive arterial disease and bouts of hypotension accompanying the haemodialysis procedure. Contrast studies of the bowel and computed tomography examination can suggest the diagnosis, but angiography alone provides the exact answer in demonstrating nonocclusive mesenteric ischaemia. In patients with chronic renal failure and longstanding dialysis presenting with abdominal symptoms this diagnosis should be considered.

Mammographic wire-guided biopsies in non-palpable breast lesions.

The use of mammography, both for diagnostic and screening purposes, is steadily increasing. It is a very sensitive examination method; findings such as an ill-defined or spiculated mass, clustered, irregular and dense microcalcifications, asymmetric densities or architectural distortion, are suggestive of malignancy. These findings are often not specific enough to make an unequivocal diagnosis of malignancy, and they are frequently not palpable. The presence of clinically occult, but mammographically present findings warrants biopsy to determine their histological nature. In order to avoid unnecessarily large biopsies and to assure the removal of the suspicious portion of the breast, precise localization in necessary, guided by mammography. Using a needle-hookwire method, 87 biopsies were done for non-palpable breast lesions detected among 3,196 mammographies performed. Experience with this method and the results show that 17 patients, i.e. every fifth biopsy, had a malignancy. In 5 patients out of 17, the findings proved to be in situ carcinoma. In another group of 17 women the biopsy result was atypical epithelial proliferation, considered to be a transitional phase of in situ carcinoma.

Subclavian artery aneurysm caused by cervical rib: case report and review.

An aneurysm in the subclavian artery is relatively uncommon and a cervical rib as the cause is rare. Such a case is presented and the pertinent literature is reviewed. The mechanism of aneurysm formation in a normal vessel wall is discussed.

Some observations on the use of computerised tomography in Legg-Calve-Perthes' disease.

The use of computerised tomography in the assessment of hip pathologies in children is an uncommonly used modality. To date, we were unable to find any definite work on the use of CAT scan investigations in LCPD. Ten children with Legg-Calve-Perthes' disease were reassessed by two-plane AP and lateral radiographs and by computerised tomography. The findings strongly suggest that computerised axial tomography is an important modality capable of providing more detailed information on the distorted anatomy, magnitude and severity of the disruptive process in the femoral head. This modality demonstrated the presence of fragmentation and cyst formation in the femoral head even if two-plane radiographs appeared to be normal.

Reevaluation of transthoracic fine needle aspiration biopsy in diagnosing superior vena cava syndrome.

Superior vena cava syndrome has various aetiologies but in the majority of cases it is caused by a malignant mass. Assessment of the underlying pathology as rapidly and reliably as possible is very important for proper therapy management. Dynamic computed tomography examination of the chest can differentiate patients in whom superior vena cava obstruction is caused by a mass, from those with a vascular aetiology. In patients with a mass, fine needle aspiration biopsy guided by the computed tomographic examination may provide cytological diagnosis in a fast and well tolerated manner.

Blast injuries.

Blast injuries cause specific lesions with which the radiologist should be familiar. The mechanism of injury and the pathophysiology of this form of trauma are discussed. The clinical effects as well as the radiologic observations in various organs are presented. Most dramatic effects are observed in the thorax.

Computed tomography in diagnosis of broncholithiasis.

A case of broncholithiasis detected by computed tomography is presented. The entity of broncholithiasis and its imaging modalities are briefly reviewed.

Pseudocyst in splenic hilus with splenic vein thrombosis. Case presentation and review.

Pseudocyst of the pancreas involving the spleen is a rare event; occlusion of splenic vein is even rarer. The mortality rate of these complications is high and therefore necessitates early diagnosis. Nuclear medicine, ultrasound and computed tomography are helpful, but definitive diagnosis is done by selective celiac or splenic artery arteriography. A case of splenic vein thrombosis due to pancreatic pseudocyst is presented and the literature on splenic involvement by pseudocyst is reviewed.

CT guided transgluteal fine needle aspiration biopsy.

CT is a suitable method for evaluation of local recurrence of rectal carcinoma after abdomino-perineal resection, as the presence of a soft tissue mass in the presacral area may be due to either residual changes from the previous surgery, or recurring disease. CT guided fine needle aspiration biopsy with a transgluteal approach was a relatively simple and fast procedure for obtaining cytological proof on the nature of the lesion in 7 out of 9 patients.

Diagnostic radiology in wartime.

During the Lebanon War, 1982, over 80% of the wounded were sent from the triage area of the hospital directly to the radiology department. This article reports changes in the working pattern and organization of the department that were instituted for emergency treatment in wartime, and describes radiological examination methods for different organs. Computerized tomography is emerging as the most important diagnostic tool in addition to conventional radiological examinations.

Diagnostic radiology in wartime

Diagnostic radiology in wartime: During the Lebanon war, 1982, over 80 percent of the wounded were sent from the triage area of the hospital directly to the radiology department. This article reports chances in the working pattern and organization of the department that were instituted for emergency treatment in wartime and describes radiological examinations methods for different organs. Computarized tomography is emerging as the most important diagnostic tool in addition to conventional radiological examinations (AU)