Cat-scratch disease: report of a case with liver lesions and no lymphadenopathy.

The usual presentation of cat-scratch disease (CSD) is a subacute regional lymphadenitis following cutaneous inoculation. We present the case of a 10-yr-old white female with a 4-wk history of abdominal pain and fever, without associated lymphadenopathy. A 67Ga scintigram showed inhomogenous uptake by the liver. An abdominal computed tomographic (CT) scan revealed multiple low density lesions in the liver and the spleen, that were confirmed at laparotomy. Stellate microabscesses were seen on a wedge biopsy of the liver and a CSD antigen skin test was positive. CSD should be considered in the differential diagnosis of liver lesions, even in the absence of lymphadenopathy. This case emphasizes the importance of inhomogeneous 67Ga uptake by the liver.

Computed tomography and magnetic resonance imaging of the acute abdomen.

CT is a noninvasive investigation that in many instances is more sensitive in elucidating intra-abdominal and retroperitoneal disease than is conventional radiography. With modern scanners, the procedure is rapid and efficient and suitable for the most severely ill and infirm. The scans are easily interpretable, and the anatomic and morphologic depiction of disease is readily understood by those with surgical training. Information regarding the state of the bowel wall, mesentery, and intraperitoneal and retroperitoneal structures is displayed in greater detail than by any other diagnostic imaging modality. The use of intravenous contrast medium is rarely essential. The concentration of iodinated contrast needed for opacification of the bowel is no greater than 2 per cent to 5 per cent and will not complicate bowel surgery, as would standard upper gastrointestinal or barium enema studies. Abscess, free air, calcium, and intraperitoneal fluid are very sensitively detected. CT is extremely useful in aiding surgical decision making in the acute abdomen and is complementary to or has replaced conventional studies.

Pseudo defect of the spleen in an adolescent with fever of unknown origin.

The development of a pseudo defect in the spleen secondary to perforation of the bowel by a 17 cm lead pencil is described. The approach to diagnosis of a foreign body in the abdominal cavity is discussed.

Magnetic resonance imaging of the adrenal glands.

Although CT should be used as the initial procedure, MRI potentially can identify most adrenal masses without the hazard of ionizing radiation or the injection of iodinated contrast material.

Benign hemangioendothelioma involving posterior mediastinum: CT findings.

We report a case of benign hemangioendothelioma of infancy extending from the deep soft tissues of the neck to involve the entire longitudinal extent of the right posterior mediastinum. The CT findings that aid in the differential diagnosis of this and other posterior mediastinal masses are discussed.

MR imaging of the adrenals: correlation with computed tomography.

The purpose of this study was to evaluate the role of magnetic resonance (MR) imaging in adrenal disease based on correlative imaging with CT. Fifty lesions in 36 patients with a variety of adrenal diseases were evaluated, at 0.5 T using spin echo (SE) multislice short repetition time (TR) and SE multislice multiecho long TR sequences. It is concluded that MR is capable of identifying most adrenal abnormalities previously detected by CT. The results suggest that MR has a greater specificity for mass lesions and might be useful to differentiate nonfunctioning adenomas from functioning adenomas, metastasis, pheochromocytomas, cysts, and intraadrenal hemorrhage. Magnetic resonance imaging also has the potential to detect aldosteronomas by increased signal intensity in addition to contour distortion using long TR/echo time sequences. The ability to perform multiplanar imaging and the presence of superior contrast as compared with CT are useful for the assessment of origin and extension of large lesions and the detection of pheochromocytomas in complex cases. Considering MR's limitations, we believe that at present its major role in evaluation of adrenal disease should be complementary to CT.

Imaging of the ischiorectal fossa.

A retrospective evaluation of 500 routine abdominal computed tomography scans revealed 21 cases of ischiorectal fossa disease in 16 patients. Pathologic processes included involvement by primary and secondary neoplasms, usually of gynecologic origin; rectal prolapse; and abscess. These abnormalities can be missed if the ischiorectal fossae are not included in routine abdominal scans. The anatomy of the ischiorectal fossae and their relationship to other pelvic organs are well demonstrated with high-resolution computed tomography scans as well as by magnetic resonance imaging.

Primary aldosteronism: computerized tomography in preoperative evaluation.

We reviewed the value of computerized tomography (CT) in the preoperative evaluation of 34 patients with primary aldosteronism. All 34 patients entered a standard protocol including saline suppression testing, abdominal CT scanning, and adrenal venous sampling. Surgical pathologic findings, biochemical determinations, and clinical response to adrenalectomy were the criteria used to evaluate 68 adrenals in 34 patients. Of 36 diseased glands 17 were correctly identified by CT (48%). Of the 32 normal glands, 29 were identified correctly by CT (91%). Thus, CT is not sensitive (0.48), but very specific (0.91) in Conn's syndrome. Our patients were divided into two groups: group 1 were those scanned between 1977 and 1980, group 2 were those scanned from 1981 to 1983 with a high-resolution GE-8800 scanner. CT results in group 2 showed no significant improvement in specificity (0.92), but improvement in sensitivity (0.58) over group 1 (specificity 0.90, sensitivity 0.42). Furthermore, CT is less sensitive in patients with smaller tumors than in those with larger tumors.

Clinical magnetic resonance imaging with nuclear medicine correlation.

The current role of magnetic resonance imaging (MRI) in different organ systems is discussed and compared to nuclear medicine and to other available clinical diagnostic modalities. The value of optimizing radiofrequency pulse sequence selection to provide additional tissue characterization is also described. The results of nuclear medicine and MRI studies in 56 patients are compared to evaluate the clinical diagnostic contribution of each imaging modality for various pathological processes. In addition, the state-of-the-art MRI systems and future development in MRI technology with its potential contribution is defined.

Abdominopelvic computed tomography: evaluation in patients undergoing second-look laparotomy for ovarian carcinoma.

Preoperative abdominopelvic computed tomography results and operative findings were compared in 52 patients undergoing second-look laparotomy to confirm tumor status. Seventeen true-negative, 22 false-negative, and 13 true-positive scans were found. The sensitivity was 0.38, specificity was 1.0, and diagnostic accuracy was 0.58. Negative studies were associated with positive findings at laparotomy in 42% of all cases. Fourteen patients were identified who had computed tomography that would have enabled an attempt at the diagnosis of persistent cancer by computed tomography-directed needle aspiration or biopsy, thus avoiding laparotomy. Assuming 80% accuracy of needle aspiration, the cost of computed tomography in all 52 patients is considerably outweighed by the savings that could have been realized by eliminating the need for second-look surgery in these 11 women.

Evaluation of renal masses by MR imaging.

Magnetic resonance (MR) imaging was performed in 20 subjects, 10 of whom had benign or malignant renal masses, and 10 were normal volunteers. The purpose of the study was to evaluate the ability of MR to provide significant diagnostic information in the management of renal mass lesions. Ten normal patients were included to supply baseline data. Different pulse sequences were used and their contribution to the diagnosis was evaluated. The emphasis has been placed on evaluating MR against the pathological diagnosis rather than other imaging modalities.