Destroyed lung: a report of cases in West Indians and Australian Aborigines

A series of patients with total destruction of one lung by bronchiectasis and a normal contralateral lung is reported. Eight cases were West Indians of Negro race and four were Australian Aborigines. The bronchiectasis appears to be of post-effective type and is related to the poor social conditions under which the affected people live. It has also been noted in other developing countries or in under-privileged races in developed countries.(AU)

Tracheobronchomegaly

Over fifty cases of tracheobronchomegaly reported in the literature are reviewed and two new cases are described. The radiological appearances of this rare condition are described and its concomitant occurrence with bronchiectasis is noted. The condition is thought to be due to faulty development of the connective tisssues of the tracheobronchial tree. However, a study of the age of presentation showed that the majority presented in the third or later decades which suggests that it is an acquired rather than a developmental anomaly. (AU)

Pleural mesothelioma associated with massive hepatic calcification and unusual metastases

A case of diffuse, malignant, pleural mesothelioma is reported in a 60-year-old Negro man. The clinical picture was most unusual; when the patient presented initially with chest pain, the radiographic appearances in the chest were normal, but extensive liver calcification was demonstrated. The latter was subsequently shown to be caused by metastases from the mesothelioma which took 2 more years to produce clinical and radiographic changes in the chest. There was microscopic evidence that the extensive liver calcification was dystrophic in nature and had resulted from marked degenerative changes and necrosis in the metastatic malignant pleural mesothelioma. Radiographs of the skeleton revealed focal, translucent lesions with sclerotic margins in the right seventh rib and the right iliac. Microscopic examination showed these bony lesions to be metastases. No previous report of secondary deposits in bone producing such radiographic appearances could be found in the literature (AU)

Bladder neck stenosis: the value of descending cysto-urethrography in the demonstration of this complication of inflammatory stricture

Attention is drawn to fibrotic stenosis of the bladder neck as a complication of inflammatory urethral stricture and ten cases with this complication in a series of 210 cases of urethral stricture are described. Descending cysto-urethrography is essential for the diagnosis and shows a narrow bladder neck instead of the normal funnel shape during the nicturition of the contrast medium. In addition, there is usually gross reflux of contrast medium into the prostatic glands and severe bladder diverticulosis. Ascending cysto-urethrography may show a "jet" effect as the contrast medium enters the bladder. Cases of stricture with bladder neck stenosis have a higher incidence of other complications than those which do not show bladder neck stenosis which suggests that the development of the stenosis may be related to the severity of the stricture. The stenosis is due to fibrosis secondary to chronic infection of the bladder neck tissues. The source of the infection is presumed to be due to the reflux of infected urine into the prostatic glands and this is always marked in cases with bladder neck stenosis. Treatment should consists of urethroplasty and resection of the bladder neck. (AU)

Comparative radiology of the proximal gastro-intestinal tract in Jamaica

A study of the radiological appearances and pathological features of a series of 17 cases of hypertrophic pyloric stenosis of the adult revealed several interesting features. It was shown that the generally accepted radiological description of smooth, severe and regular narrowing and elongation of the pyloric canal is only present in a proportion of cases. The radiological picture is very variable and many cases presented with an irregular pyloric canal and antrum with only moderate degree of narrowing or of pyloric stenosis. The classical pathological changes are said to be those of hypertrophy and hyperplasia of the circular muscle of the pyloric canal and adjacent part of the antrum. The use of special staining techniques revealed varying amounts of fibrous tissue in the hypertrophied smooth muscle in every case, a feature only briefly referred to in one or two previous communications. The presence of fibrous tissue is compatible with the theory that hypertrophic pyloric stenosis of the adult is secondary to pyloric channel ulcer and further evidence is presented in support of this. In a significant proportion of cases, the pyloric muscle hypertrophy is complicated by the presence of a benign ulcer on the lesser curvature of the stomach. The significance of this is also discussed

Histogenesis of intrapulmonary and endobronchial hamartomas and chondromas (cartilage-containing tumors): a hypothesis

A study of selected examples from a series of 42 cartilage-containing tumors of the lung support the hypothesis that intrapulmonary hamartomas and chondromas and endobranchial hamartomas and chondromas are the same lesion and are neoplasms that arise in the connective tissue of the bronchial walls. The apparent differences in the appearance of these neoplasms are due to their site of origin. i.e., whether they arise in large or small bronchi, and their direction of growth, i.e., whether they grow into or away from the lumen of the bronchus of origin. They should all be referred to as cartilage containing tumors of the lung and bronchi. (Summary)

Duodenal ulcer and carcinoma of the stomach: a rare association - abstract

Recently, a barium meal examination performed on a middle-aged man referred to the X-ray Department for investigation of gastro-intestinal symptoms demonstrated deformity of the duodenal bulb consistent with scarring from a chronic duodenal ulcer and a filling defect of the fundus of the stomach consistent with a carcinoma. A bone marrow examination demonstrated the presence of malignant cells which could be metastases from a gastric neoplasm. Therefore, there is good evidence of the co-existence of duodenal ulcer and cancer of the stomach in this patient. However, a review of the literature revealed that although carcinoma of the stomach is not uncommon in patients who have had an operation for duodenal or gastric ulcer it is extremely rare in patients who have a duodenal ulcer and have not undergone surgical treatment. This rare association was confirmed by a review of 3,800 barium swallow and meal examinations. Of these examinations, 1077 demonstrated a duodenal ulcer and association was noted to be common with gastric ulcer, hiatus hernia, hypertrophic pyloric stenosis and duodenal diverticula and also to occur with carcinoma of the oesophagus and pancreas but not a single examination demonstrated duodenal ulcer and carcinoma of the stomach in the same patient. This lack of association is even more striking because in the same series of barium examinations there were 173 cases of carcinoma of the stomach which next to duodenal ulcer, was the most common lesion (AU)

Kaposi's sarcoma in West Indies

Clinical and pathological features are presented of 3 cases of Kaposi's sarcoma, thought to be the first confirmed cases in the British Commonwealth West Indies. The results of angiography done on one case is given; amyloidosis complicated the natural history in this case. An association between Kaposi's sarcoma and amyloidosis has not been previously noted in the available literature. The rarity of the disease in this predominantly African population, derived mainly from West Africa, is added evidence that environmental factors are responsible for the disease (AU)

Ossified bronchial adenoma

A case of bronchial adenoma is reported which presented radiologically as an extensively calcified hilar mass on a routine chest radiograph of a patient undergoing surgery for varicose veins. This is of interest because, although bronchial adenomas may present in this way (Zellos, 1962; Baldwin and Grimes, 1967), calcification is not regarded as one of their radiological features. (AU)

Carcinoma of the oesophagus: comparison of two radiological series from Jamaica and Western Australia

Two radiological series of carcinoma of the oesophagus from Kingston, Jamaica, and Perth, Western Australia, are compared. The populations of these two cities show marked differences in race, alcohol consumption and diet, all factors which are thought to play a part in the causation of carcinoma of the oesophagus. In spite of these diffeences the age distribution, sex ratio, automatical distribution and extent of involvement of the oesophagus by this tumour showed marked similarity in these two radiological series. This suggests that the behaviour of carcinoma of the oesophagus is not modified by differences in race or environment in Jamaica and Western Australia. (Summary)

Duodenal and antral varices in portal hypertension - abstract

Varices of the oesophagus and of the fundus of the stomach are well recognised and frequently demonstrated in patients with portal hypertension. An analysis of 3,800 barium swallow and meal examinations performed in the X-ray Department of the University Hospital revealed forty-two patients with oesophageal varices secondary to portal hypertension. In twenty-four of these cases, the barium swallow had been extended to include examination of the stomach and duodenum. Eighteen of these twenty-four cases showed filling defects of the duodenal bulb and a few had filling defects of the antrum of the stomach. Evidence is presented, including special barium studies, percutaneous spleno-porto-venography and autopsy examination, which shows that the filling of the duodenal bulb and gastric antrum are probably due to varices similar in nature to these found in the oesophagus. There is also anatomical evidence for the existence of varices of the dudenum and gastric antrum(AU)

Concomitant gastric and duodenal ulcers

Three thousand eight hundred consecutive barium meal examinations performed in the X-ray Department of the University Hospital of the West Indies are analysed. A high percentage of the cases with gastric ulcers were found to have concomitant duodenal ulcers. The relationship between the gastric ulcer and duodenal ulcer in cases with concomitant ulcers is discussed and evidence from the present series and the literature suggests that the gastric ulcer is secondary to the duodenal ulcer in these cases. Two theories of the cause of gastric ulcer, (a) the retention theory and (b) the reflux theory, especially in relation to concomitant gastric and duodenal ulcers, are reviewed. The reflux theory appears to be the most acceptable, and on the basis of this theory, gastric ulcers are classified into (a) primary and (b) secondary (concomitant) to duodenal ulcer or pyloric channel disease (pyloric ulcer or hypertrophic pyloric stenosis). The high incidence of concomitant gastric and duodenal ulcers in Jamaica is compared with the incidence in other countries. It is shown that the incidence of these concomitant ulcers depends upon two factors, which are, the duodenal ulcer, gastric ulcer ratio and the incidence of gastric ulcers which are secondary to duodenal ulcers. In Jamaica, both these factors are high which accounts for the high incidence of concomitant ulcers. (AU)

"Coin" lesions of the chest: A review of fifteen cases seen in the University Hospital of the West Indies

A review of fifteen coin lesions of the chest from the University Hospital of the West Indies is presented. Six of the coin lesions were benign and nine were malignant. Twelve of the cases had no symptoms referable to the chest and were accidental findings on routine chest radiographs. The radiological appearances are discussed and it was found impossible to differentiate the benign from the malignant lesions. The impossibility of making a definite pre-operative diagnosis, the low operative mortality, the high incidence of malignancy, and the possibility of cure in malignant cases make surgical resection the treatment of choice. In three cases, other concomitant primary tumours were present (carcinoma of cervix, meningioma and pituitary tumour) and in a fourth case, a desmoid tumour developed in the scar on the chest wall following the resection of the coin lesions. (AU)

Radiological and pathological observations in a series of seventeen cases of hypertrophic pyloric stenosis of adults

A study of the radiological appearances and pathological features of a series of 17 cases of hypertrophic pyloric stenosis of the adult revealed several interesting features. It was shown that the generally accepted radiological description of smooth, severe and regular narrowing and elongation of the pyloric canal is only present in a proportion of cases. The radiological picture is very variable and many cases presented with an irregular pyloric canal and antrum with only moderate degree of narrowing or as pyloric stenosis. The classical pathological changes are said to be those of hypertrophy and hyperplasia of the circular muscle of the pyloric canal and adjacent part of the antrum. The use of special staining techniques revealed varying amounts of fibrous tissue in the hypertrophied smooth muscle in every case, a feature only briefly referred to in one or two previous communications. The presence of fibrous tissue is compatible with the theory that hypertrophic pyloric stenosis of the adult is secondary to pyloric channel ulcer and further evidence is presented to support this. In a significant proportion of cases, the pyloric muscle hypertrophy is complicated by the presence of a benign ulcer on the lesser curvature of the stomach. The significance of this is also discussed. (AU)

Circumcaval ureter: a new classification

The authors have studied the radiographic appearances of two of their patients with circumcaval ureter and reviewed the findings in a further 87 cases reported in the literature. They define two types of patterns: (a) The slightly commoner form has a moderate or severe hydronephrosis and an 'S' or 'fish-hook' deformity of the ureter at the point of obstruction. They demonstrate that the point of obstruction is placed some distance from the lateral margin of the inferior vena cava. (b) The second form has a mild hydronephrosis and a 'sickle-shaped' curve of the ureter at the point obstruction. The obstruction coincides with the lateral margin of the inferior vena cava in this type. The generally accepted explanation that pressure by the inferior vena cava explains the second type, but not the first. The cause of the hydronephrosis in the first form is not clear. The authors suggest that it is due to an associated anomaly in the development of the ureter where it crosses the lateral border of the psoas muscle. (AU)

Duodenal and antral varices

Oesophageal and gastric fundal varices can be demonstrated by barium examination in over 50 per cent of cases with portal hypertension. It is not generally recognised that varices may occur also in the duodenal bulb, pyloric antrum and in other parts of the alimentary tract. The author reports 18 cases of portal hypertension shown to have oesophageal varices who had lobulated filling defects of the pyloric antrum were also found. In three, these defects were shown by spleno-portography to be caused by dilated portal venous radicles and evidence is presented to suggest a similar cause in the remaining cases. Varices in this situation are due to anastomoses between branches of the superior mesenteric vein and retro-peritoneal veins. The differential diagnosis and significance of duodenal and antral varices is discussed. (AU)

Radiology and pathological observations of a series of seventeen cases of hypertrophic pyloric stenosis of adults (abstract only)

Hypertrophic pyloric stenosis of the adult is a well recognised radiological and pathological entity, with characteristic radiological appearance and typical pathological changes due to hypertrophy and hyperplasia of the circular muscle of the pyloric sphincter and adjacent part of the pyloric antrum. A study of seventeen cases with radiological investigation and surgical treatment at the University Hospital of the West Indies was undertaken. Only six of these cases had the classical radiological appearance of a narrowed and elongated pyloric canal. Six cases showed minimal narrowing but marked irregularity of the pylorid antrum and canal, the appearance usually described as antral gastritis. Four cases presented as pyloric stenosis. The radiographs were not available in the seventeenth case. There was a high incidence of lesser curve gastric ulcer and the significance of this is discussed. The macroscopic appearances were typical of this condition. The use of a special staining technique demonstrated that in addition to muscle hypertrophy, there was also much fibrosis between the muscle bundles. This suggests that the condition may arise from a prepyloric ulcer and evidence is presented in support of this. (AU)

Radiological presentation of bronchogenic carcinoma in Jamaica

Bronchogenic carcinoma is not an uncommon disease in Jamaica and usually presents radiologically as a hilar mass, collapse and/or consolidation, a peripheral shadow opacity of one hemi-thorax. Comparison of the radiological appearances with those of other series shows that the main difference is the presence of those cases with complete opacity of one hemi-thorax. This radiological appearance indicates an advanced stage of the disease due to the fact that patients seek medical advice at a late stage. The relative frequency of peripheral and central cases in the Jamaican series is similar to that found in the United States of America and the United Kingdom and France, suggesting that on the basis of the radiological appearance, bronchogenic carcinoma in Jamaica is similar to the disease in other parts of the world (AU)