Adrenal arteriography and venography.

Although no longer the primary diagnostic examination, angiography of the adrenal gland remains a safe, reliable tool for identifying adrenal disorders. Selective venous sampling for hormone assay is important in localizing functional adrenal lesions.

The solitary pulmonary nodule and staging of lung cancer.

More favorable survival rates are encountered when a bronchogenic carcinoma is identified and resected at the asymptomatic, small, circumscribed, nodular stage. The only two reliable radiologic criteria for benignity are the long-term absence of growth and certain characteristic patterns of calcification. With the advent of computed tomography, the preoperative radiographic staging of non-small cell bronchogenic carcinoma can accurately select those patients for potential surgical care.

Valproate in very young children: an open case series with a brief follow-up.

We report nine cases of juvenile mania, of which six began in the preschool years. We provide validation by clinical description, family history of bipolar disorder, worsening on stimulants, and considerable mood stabilization with divalproex. This is a relatively new area of clinical observation, and systematic studies are needed to firmly establish this diagnostic category in very young children. Our case series enriches the existing scant literature and provide the rationale for the use of mood stabilizers rather than stimulants in this juvenile population. However, no controlled studies exist on the efficacy and safety of valproate in this age group; lithium that has received greater clinical attention, has not been subjected to controlled studies either. Our clinical observations with divalproex are preliminary but encouraging.

Pulmonary metastases from intracerebral meningioma. Diagnosis by percutaneous needle aspiration biopsy.

A case of metastatic meningioma to the lung is reported and the recent literature reviewed. This case was diagnosed solely by cytologic examination of fine needle aspiration biopsy. Pulmonary metastases are relatively rare and the diagnosis by this method has not previously been reported.

The effects of a preoperational puppet show on anxiety levels of hospitalized children.

This study investigated effects of a preoperative puppet show on anxiety levels of hospitalized children as measured by the Palmar Sweat Index (PSI). Subjects were 28 children, ages 2-7 years inclusive, randomly assigned to treatment and nontreatment groups. Treatment consisted of a puppet show designed to familiarize patients with hospital routines and operational procedures. Two PSI measures were collected for each subject. Analyses of variance were used to test mean differences with data categorized by treatment, by sex, and by interaction of sex and treatment. No interaction was found between treatment and sex. Treatment was associated with a significant reduction in anxiety from the time of admission to the period immediately following the puppet show.

Computed tomography of the tracheal bronchus.

Tracheal bronchus is an uncommon anomaly in which an ectopic bronchus arises from the trachea above the carina. It occurs on the right side and two types are described: "supernumerary," which is associated with a normal trifurcating right upper lobe bronchus, and "displaced," in which instance the ectopic bronchus supplies the apical segment of the upper lobe. The CT appearance of this anomaly is described in two cases. Findings include identification of a bronchus arising from the trachea in a section more cephalad than the carina and the presence of only two segmental bronchi arising from the anatomic right upper lobe bronchus when the anomaly is of the "displaced" type. Thin axial sections and coronal imaging display the tracheal bronchus to best advantage.

Computed tomography of localized pleural mesothelioma.

The computed tomographic (CT) features of six pathologically proven cases of fibrous mesothelioma were reviewed. There were no pathognomonic CT characteristics, but in all cases CT suggested or supported the preoperative diagnosis. CT findings included well delineated, often lobulated, noncalcified soft-tissue masses in close relation to a pleural surface, associated crural thickening, and absence of chest wall invasion. An obtuse angle of the mass with respect to the pleural surface was not particularly useful. Rather, a smoothly tapering margin was more characteristic of a pleural lesion.

Pseudometastases secondary to film static artifact.

Low density areas in the liver on computed tomography (CT) may be produced by cysts, abscesses, or tumors. A case is reported in which film static resulted in multiple focal low density areas in the liver in a patient with lymphoma. This potential pitfall in CT interpretation can be avoided by taking proper measures to avoid film artifacts and by reviewing all cases on the cathode ray tube (CRT) display as well as the hard copy film.

Dynamic incremental computed tomography of the pulmonary hila using a flow-rate injector.

Dynamic incremental CT of the pulmonary hila using a flow-rate injector is a safe, reliable, and reproducible technique. The technique described allows confident distinction of hilar masses from hilar vessels, while limiting the total amount of contrast medium used and eliminating radiation exposure to the radiologist.

Entanglement of a pigtail catheter by the chordae tendineae of the tricuspid valve during pulmonary angiography.

Two cases are presented in which a pigtail catheter was entrapped by the chordae tendineae of the tricuspid valve during pulmonary arteriography. A technique for removal of the catheter from its entanglement by the chordae tendineae is described. Caution must be taken when advancing through the right ventricle a catheter that appears to be entrapped by the chordae tendineae. When such an entanglement occurs, measures to reduce the risk of rupturing a papillary muscle must be taken.

Transthoracic needle aspiration biopsy: evaluation of the blood patch technique.

A study was undertaken to evaluate the effectiveness of the blood patch technique in the prevention of pneumothorax after transthoracic needle aspiration biopsy. A total of 140 needle biopsies were performed with a coaxial system. Two groups of patients were defined according to whether or not autologous blood was injected into the introducing needle as it was withdrawn after needle aspiration biopsy. Fifty-two biopsies were performed with the blood patch technique (group A), while 88 biopsies were performed without the blood patch technique (group B). The frequency of postbiopsy pneumothorax was 28.8% (15 of 52 patients) in group A and 34.1% (30 of 88 patients) in group B. Chest tube insertion was required in 7.7% (four of 52 patients) in group A and in 9.1% (eight of 88 patients) in group B. There was no statistically significant difference in pneumothorax rate and chest-tube insertion rate between the two groups (P greater than .05). In this series of 140 biopsies, the blood patch technique failed to affect the rate of pneumothorax after transthoracic needle aspiration biopsy.

Transbrachial hepatic arterial chemotherapy using an implanted infusion pump.

Two patients with hepatic metastases from colonic cancer were treated with hepatic arterial FUDR using an innovative drug infusion system. The two patients reported underwent transbrachial hepatic artery catheterization with a 5 French polyethylene catheter. This catheter was amputated just distal to its exit from the brachial artery and attached to a totally implantable, percutaneously refillable drug infusion pump placed in the infraclavicular position. The patients received FUDR at flow rates of 3--4 ml/day. The pumps were refilled weekly by percutaneous injection. One patient was treated for seven weeks, and another for ten weeks without technical difficulties. This innovative approach offers marked improvement in comfort and convenience for patients who are candidates for long-term hepatic artery chemotherapy, and avoids the morbidity of laparotomy for direct hepatic arterial catheterization.

Thymic cysts in mediastinal Hodgkin disease.

Three cases of proved thymic cysts associated with mediastinal Hodgkin disease are presented. Two illustrate regression of lymphoma with chemotherapy but persistence of thymic cysts. The third case demonstrates a thymic cyst in untreated Hodgkin disease. These cases suggest that such cysts are probably neither coincidental with nor a consequence of therapy but are probably related to initial thymic involvement by Hodgkin disease.

Right-pneumonectomy syndrome: radiologic findings and CT correlation.

The clinical history and radiographic and bronchoscopic findings were reviewed retrospectively in five patients with right-pneumonectomy syndrome, a rare, delayed complication of pneumonectomy of the right lung. Four patients had undergone pneumonectomy in childhood or adolescence. Presenting symptoms of dyspnea and recurrent pulmonary infections in the left lung were associated with radiographic evidence of marked rightward and posterior deviation of the mediastinum, counterclockwise rotation of the heart and great vessels, and herniation of the left lung into the right, anterior side of the chest. Computed tomography, performed in four patients, best demonstrated resultant compression of the distal trachea and left main bronchus between the aorta and pulmonary artery. Malacia of the major airways (n = 4 cases) and mediastinal shift was visualized only with fluoroscopy and was confirmed by bronchoscopy. Because of the morbidity and mortality associated with dyspnea and recurrent pulmonary infections, proper radiologic evaluation is crucial, and surgical intervention is often necessary.

CT of adenoid cystic carcinoma of the trachea.

The CT features of six cases of adenoid cystic carcinoma of the trachea are presented and compared to the bronchoscopic, surgical, and pathologic findings. CT accurately demonstrated extratracheal extension of tumor, which occurred in all six cases and which was not visible on standard chest radiographs. This information was helpful in planning the surgical approach. However, CT consistently underestimated the longitudinal extension of the lesion because of partial volume averaging and the tendency of adenoid cystic carcinoma to grow submucosally. CT was also a poor predictor of mediastinal organ invasion. Because recent advances in tracheal resection and carinal reconstruction have made many of these lesions resectable, CT is frequently used in the evaluation of the operability of patients with adenoid cystic carcinoma. However, its usefulness in this regard is limited, and conventional techniques such as standard tomography continue to play a role in preoperative assessment.

Low-dose flying spot digital radiography of the chest: sensitivity studies.

Standard film examinations of the chest were compared with low-dose flying spot digital radiographic examinations obtained with a prototype unit in 174 patients. Analysis of pooled data from a double-blind study of 120 patients showed that film was more sensitive than digital images in the detection of pulmonary parenchymal abnormalities, that is, abnormal opacities, atelectasis, scar, and interstitial lung disease (P less than .05). Analysis of pooled data from a side-by-side study of 54 patients showed that the digital images were more sensitive than film in the detection of normal mediastinal and pleural soft-tissue contours, including the azygoesophageal recess, paraspinal line, and vertebral disk spaces (P less than .05). However, film was more sensitive than digital images in the detection of abnormalities of the lung, including scar, interstitial lung disease, septal lines, and the presence of vascular catheters (P less than .05). These findings suggest that low-dose flying spot digital radiography of the chest, as performed with this specific prototype unit, is not adequate to replace film in the detection of abnormalities of the lung parenchyma.