Ultrasonography of the rotator cuff. Normal and pathologic anatomy.

Forty-eight patients with shoulder pain and 15 normal volunteers underwent rotator cuff imaging using high resolution real time ultrasound. The potential diagnostic value of sonography in detecting rotator cuff tears was evaluated by correlating ultrasound findings with surgical findings in 19 patients, 12 of whom also underwent preoperative arthrography. The preoperative ultrasound diagnosis was correct in 18 of the 19 patients undergoing surgery for possible rotator cuff tears. In the group of 12 surgical patients undergoing both preoperative arthrography and sonography, ultrasound correctly predicted the presence of a rotator cuff tear in 12 of 12 patients, while arthrography predicted cuff tears in only nine of 12. Good anatomic definition of the rotator cuff was obtained in both symptomatic and asymptomatic groups. The characteristic appearance of the normal and pathologic rotator cuff is described. Rotator cuff sonography promises to be a valuable new diagnostic tool for evaluating patients with suspected rotator cuff tears.

CT of pancreas transplantation.

Thirty-eight abdominal CT examinations obtained on 20 patients after pancreas transplantation were reviewed to determine the CT findings associated with pancreas transplantation and to assess the clinical utility of CT in this setting. Visualization of the transplanted pancreas was variable and was strongly influenced by adequacy of gastrointestinal opacification with contrast material. In four cases, linear high-density material was present within the graft, which, depending upon the surgical technique for handling exocrine secretions, represented either pancreaticojejunal stents or silicone within the pancreatic duct. Abdominal fluid collections were identified in 19 patients and were the most common complication identified by CT. Four of these collections were drained percutaneously. The major value of CT in pancreas transplantation is the identification and management of abdominal fluid collections in patients with abdominal pain and fever.

Ultrasound and computed tomographic evaluation of renal transplantation.

Ultrasound and computed tomography are very useful in the diagnosis of parenchymal and urologic abnormalities after renal transplantation. The increased use of Doppler duplex sonography will further enhance the role of ultrasound in the evaluation of patients with kidney transplants. Computed tomography is of particular value in the setting of suspected posttransplant malignancy. Both imaging techniques can be used to guide diagnostic and therapeutic interventional radiologic procedures.

Ultrasound and computed tomography in the evaluation of pancreatic transplantation.

Both ultrasound and computed tomography are useful imaging modalities in the evaluation of pancreatic transplants and their complications. Ultrasound and computed tomography are most valuable in the detection of peripancreatic fluid collections, although some parenchymal abnormalities can occasionally be detected. Directed diagnostic aspiration is useful in determining the etiology of peripancreatic and other peritoneal fluid collections. The role of percutaneous catheter drainage in the management of these complex patients is not yet clearly defined.

Ultrasound and computed tomographic evaluation in hepatic transplantation.

Ultrasound and CT are valuable in the non-invasive evaluation of complications of hepatic transplantation. Ultrasound is particularly helpful in detecting biliary obstruction and in documenting vascular patency. As with renal transplantation, the value of US in the assessment of rejection will likely increase with time. Computed tomography is most valuable in identifying large parenchymal abnormalities and abdominal fluid. Both US and CT can be used to guide diagnostic and therapeutic percutaneous procedures in hepatic transplant recipients.

Carcinoembryonic antigen in a metastatic brain tumor.

A case is presented in which 10 ml of cystic fluid from a metastatic brain tumor contained a high concentration of carcinoembryonic antigen (CEA). The use of CEA as a prognostic indicator and adjunctive therapeutic monitor in tumors is reviewed.

Significance of pneumatosis cystoides intestinalis after jejunoileal bypass.

In 148 radiographs taken two weeks to twenty-seven months postoperatively in a series of 402 jejunoileal bypass patients at the University of Minnesota, twenty-four patients demonstrated roentgen evidence for pneumatosis intestinalis on twenty-eight separate episodes. This primarily involved the right colon. Clinical signs and symptoms were reviewed in association with the roentgen findings. Symptoms of nausea, vomiting, fever, and abdominal stress were noted but were not universal. Six patients had no significant change in abdominal complaints at the time the pneumatosis was seen and seven patients had similar clinical findings without roentgen evidence for pneumatosis. Thus, the radiographic findings of pneumatosis intestinalis do not represent a specific sign for bypass enteritis.

Sonography of the postoperative rotator cuff.

In experienced hands, high-resolution real-time sonography has been shown to be an accurate noninvasive method for diagnosis of rotator cuff tears. The sonographic appearance of the postoperative rotator cuff has not been previously reported. Forty postoperative patients were studied sonographically 1 week to 6 years after rotator cuff repair. The postoperative rotator cuff is abnormally echogenic and can be very similar in appearance to a small rotator cuff tear in a nonoperated patient. Soft-tissue planes about the tendon are distorted or absent. Criteria for diagnosis of retear must be different from those used in detecting new tears in a nonoperated cuff. Postoperative echogenicity is normal, but the finding of a defect or gap within the rotator cuff tendon is the only accurate sign of a recurrent rotator cuff tear.

Clinical significance of sonographic findings in the abnormal but intact rotator cuff: a preliminary report.

Shoulder pain is a common orthopedic problem. Clinical examination is often nonspecific and arthrography is normal in those patients with the most frequent cause of shoulder pain--noncalcific tendonitis secondary to impingement. Ultrasonography has recently shown itself to be of value in the diagnosis of rotator cuff tears. In addition to the diagnosis of tears, however, sonography can demonstrate abnormalities within the intact rotator cuff tendon. These abnormalities consist of changes in echogenicity and thickness of the tendon. The patterns of abnormality demonstrated correlate with pathologic changes seen in tendonitis. This preliminary study suggests that the ability to demonstrate an abnormal rotator cuff tendon has potential for becoming a valuable aid to the orthopedist in allowing confident diagnosis of rotator cuff disease in the presence of nonspecific symptomatology and an intact tendon.

Ultrasonography of rotator cuff tears: a review of 500 diagnostic studies.

Ultrasonography of the rotator cuff has been shown to be of value in diagnosing rotator cuff tears. This report summarizes our experience with our first 500 diagnostic examinations. All patients were examined in the hyperextended internal rotation view with commercially available high-resolution real-time ultrasound equipment. Patients were diagnosed as having a rotator cuff tear if a focal echogenic lesion or a defect within the rotator cuff was identified. This study confirmed the value of ultrasonography for the diagnosis of rotator cuff tears. Accuracy, sensitivity, and specificity all exceeded 90%, and correlated with surgical findings. This was better than arthrography in the same patient population. Ultrasound is an accurate noninvasive method of examining the rotator cuff for the presence of tears. We suggest that rotator cuff ultrasonography is the procedure of choice for the diagnosis of tears if adequate instrumentation is available.

Retrorectal herniation of the sigmoid colon: report of a case.

A rare retrorectal hernia of the sigmoid colon associated with diverticulitis and a presacral abscess is reported. The anatomy of the retrorectal space is reviewed. The value of routine lateral fluoroscopy and overhead films is emphasized.

The value of endoscopic retrograde cholangiopancreatography in patients with suspected carcinoma of the pancreas and indeterminate computed tomographic results.

Endoscopic retrograde cholangiopancreatography was used to evaluate 26 patients with clinically suspected pancreatic malignant growths and indeterminate compute tomographic result. Endoscopic retrograde cholangiopancreatography benefited preoperative diagnosis or clinical management in 25 of 26 patients by diagnosing carcinoma in six, chronic pancreatitis in ten or normal pancreas in nine. Endoscopic retrograde cholangiopancreatography missed one carcinoma in a chronically inflamed pancreas. Endoscopic retrograde cholangiopancreatography is useful in evaluating patients with indeterminate pancreatic computed tomographic results prior to exploratory laparotomy.

Comparison of ultrasound pancreatic scanning and encoscopic retrograde cholangiopancreatograms: a retrospective study.

In a retrospective study comparing ultrasonography and endoscopic retrograde cholangiopancreatograms (ERCP) of the pancreas we found ultrasound 93.8% accurate and ERCP 62.5% accurate in detecting pancreatic pathology. Thus, sonography provides a safe screening procedure and ERCP provides a complementary approach.

Sonography of abdominal posttransplant lymphoma.

Five patients developed abdominal lymphoma an average of 89 months after successful renal transplantation. Sonographically, the lymphomas presented as bulky intraperitoneal masses or focal deposits in the liver. These lesions exhibited good sound transmission and intrinsic patterns ranging from sparse, soft echoes to coarse trabeculations. Prompt diagnosis of this serious late complication of renal transplantation is crucial.