Use of the pulsed dye laser and ultrasonic lithotriptor for removal of multiple intrahepatic gallstones.

Two established urologic modalities used for removal of kidney stones were applied in a complementary manner for percutaneous transhepatic removal of multiple intrahepatic gallstones. A pulsed dye laser was used through a flexible nephroscope to fragment a large impacted stone. A stone basket was used to remove stone fragments and a few small entrapped stones. Subsequently, an ultrasonic lithotriptor carried by a rigid nephroscope was tried and found to be a much more efficient means of removing the remaining small stones.

Imaging of foregut duplication cysts.

There are many types of diagnostic imaging studies available for the evaluation of foregut duplication cysts. Esophagography may be helpful in confirming the presence of a mediastinal mass, explaining esophageal symptoms, or defining the location of a lesion, but it is rarely diagnostic. Digital subtraction angiography can successfully be used in place of pulmonary arteriography to define vascular anatomy. Computed tomography is often diagnostic, although the attenuation number may be slightly elevated and not that of water. Computed tomography will clarify the relationship of the mass to adjacent mediastinal structures, and may also assist in percutaneous guided aspiration. Surgical resection is often necessary in an infant because of respiratory distress with airway compromise. In asymptomatic patients with a round to oval, nonenhancing, thin walled, cystic mass demonstrated on CT, a thoracotomy may be avoided and the patients may be followed by chest radiography.

Portal vein thrombosis shown by ultrasonography.

While alcoholic cirrhosis is the most common cause of portal hypertension and associated gastrointestinal bleeding, portal vein occlusion can produce similar clinical manifestations. Ultrasonography is an accurate, noninvasive procedure for detecting portal vein thrombosis and distinguishing infrahepatic venous obstruction from intrahepatic obstruction due to cirrhosis.

Visceroatrial situs abnormalities: sonographic and computed tomographic appearance.

Twenty patients with visceroatrial situs abnormalities were examined by sonography or computed tomography (CT). Eighteen patients underwent cardiac catheterization. Left isomerism (polysplenia syndrome) was found in seven patients, right isomerism (asplenia syndrome) in eight, and total situs inversus in five. The abdominal features of polysplenia include interruption of the inferior vena cava with azygous/hemiazygous continuation (100%) and multiple splenules. The diagnostic signs of asplenia include an inferior vena cava and aorta that course together on the same side of the spine with inferior vena cava-atrial communication (100%). In each case, the key differential feature relates to the major abdominal vessels. Sonography or CT examination in cases of situs ambiguus may reveal diagnostic features that can be used with radiographic signs to accurately diagnose the visceroatrial situs.

Ultrasonography and focal vascular disease.

The major vascular structures in the retroperitoneum are valuable landmarks for the ultrasonographer. Two cases of focal disease, one involving the pancreatic region (an aneurysm of the superior mesenteric artery) and another involving the kidney (a renal arteriovenous fistula) are presented to emphasize the importance of considering a vascular origin in the differential diagnosis of obscure sonolucent masses.

Focal splenic defects.

Review of more than 2,000 liver-spleen scans revealed 18 cases of focal splenic defects. Three major categories are defined: lymphoma, infarctions, and metastatic tumor. Clinical presentation is important in determining the precise etiology, and a differential diagnosis is presented. It appears that: (a) reticulum cell carcinoma is as likely to cause defects as is Hodgkin's disease; (b) splenic infarction is related to pancreatic disease through the splenic vein; and (c) malignant melanoma is the most common secondary deposit as detected by scanning.

Manifestations of hypertrophic pulmonary osteoarthropathy in patients with carcinoma of the lung. Demonstration by 99mTc-pyrophosphate bone scans.

Two patients with carcinoma of the lung were studied with 99mTc-stannous pyrophosphate. Resolution of scintigraphic activity was observed postoperatively in one patient, while the second patient showed an asymmetric pattern of radionuclide uptake and radiographic changes as well as clinical findings of hypertrophic pulmonary osteoarthropathy.