Intracranial complications of pediatric hematologic disorders: computed tomographic assessment.

Computed tomography (CT) findings in the intracranial complications of leukemia, hemophilia, and sickle cell anemia were reviewed in 19 children with these hematologic disorders. CT demonstrated intracranial hemorrhage, infarction, intracerebral mass, and post-therapeutic atrophy and leukoencephalopathy in leukemic children. Intracerebral, subarachnoid, subdural, and epidural hemorrhage was documented in patients with hemophilia. Bland and hemorrhagic infarctions were identified in children with sickle cell anemia. CT proved valuable in documenting the presence and extent of these abnormalities, titrating factor replacement in hemophiliac patients, and monitoring therapeutic toxicity in leukemic patients.

Acquired double pylorus due to gastroduodenal fistula complicating peptic ulceration.

Fistulous communication between the gastric antrum and the duodenal bulb had the roentgenographic appearance of a double-channel pylorus in five adult patents. A penetrating peptic ulcer was the underlying cause in each instance. Following conservative management, the fistula in two cases closed spontaneously and in two other cases became asymptomatic despite persistence of the accessory channel. The remaining patient underwent subtotal gastrectomy because of hemorrhage from nonhealing antral ulcer.

Cavernous hepatic hemangioma simulating metastatic renal cell carcinoma.

A case of cavernous hemangioma of the liver resembling a metastatic deposit is reported in a patient with renal cell carcinoma. The clinical and angiographic features that distinguish hepatic hemangiomas from metastatic renal cell carcinoma are discussed. The importance of this distinction in patient management is emphasized.

Cross-sectional imaging of inflammatory bowel disease.

The cross-sectional imaging modalities provide an important diagnostic perspective in patients with inflammatory bowel disease that often has a profound influence on the therapeutic decision-making process. They can directly and noninvasively image infectious and inflammatory complications involving the bowel wall, serosa, and mesentery that can only be assessed indirectly by colonoscopy and barium studies. At the present time, CT is superior to ultrasound and MR in diagnosing these extramucosal complications.

CT of inflammatory bowel disease.

Computed tomography (CT) provides an important perspective in patients with inflammatory bowel disease that often has a profound influence on the therapeutic decision-making process. By virtue of its ability to image the bowel wall, serosa, and mesentery directly and noninvasively, CT can diagnose infectious and inflammatory complications that often can only be inferred indirectly by barium studies and endoscopy.

Esophageal cancer. Clinical and pathologic features.

Carcinoma of the esophagus remains one of the most lethal of all cancers. In the past, squamous cell carcinomas accounted for over 95% of esophageal malignancies. Over the past two decades, however, there has been a dramatic increase in the incidence of adenocarcinoma arising in columnar cell-lined Barrett's mucosa, accounting for up to 34% of all esophageal cancers in some areas. This article discusses the different demographic, pathologic, therapeutic, and prognostic features of squamous cell and adenocarcinoma of the esophagus.

Gastric cancer. Clinical and pathologic features.

Gastric cancer is one of the leading causes of cancer mortality worldwide. Very little progress has been made in improving the dismal cure rate of gastric cancer over the last 30 years in the United States. Unless major breakthroughs develop in chemotherapy or radiation therapy, the only way to improve survival rates rests with earlier recognition and prevention.

Small bowel cancer. Clinical and pathologic features.

Although the small bowel constitutes over 75% of the length and 90% of the mucosal surface of the alimentary tract, it is the site of only 1% of gastrointestinal cancers. Despite their rarity, it is important to diagnose small bowel tumors early to maximize patient survival. This article focuses on the clinical and pathologic findings of small bowel adenocarcinomas and carcinoids.

Colorectal cancer. Clinical and pathologic features.

Despite an improved understanding of the pathogenesis of colorectal cancer and the technical ability to alter its natural history in a large proportion of average and high-risk patients, this cancer remains deadly. There has been no significant change in incidence or survival rates over the past 40 years. This indicates a continued need for earlier detection of polyps and cancers, aggressive surgery for the primary tumor, and improved multimodality treatment for metastatic disease.

CT diagnosis of postoperative abdominal complications.

Over 3 million abdominal operations are performed in the United States each year, and a significant number of these patients subsequently undergo computed tomography (CT) either for follow-up of resected lesions or evaluation of possible postoperative complications. This article describes the clinical presentations and CT features of commonly encountered postsurgical complications. A wide spectrum of lesions involving the abdominal wall as well as intraperitoneal structures is herein illustrated to emphasize the role of CT in their diagnosis and management.

Gastric cancer. Radiologic diagnosis.

The development and refinement of double-contrast barium techniques over the past two decades have dramatically improved the radiologist's ability to detect gastric cancer and characterize gastric ulcers. This article presents the radiologic findings of both early and advanced gastric cancer and offers guidelines for differentiating benign versus malignant gastric ulcers.

Gastric cancer. Radiologic staging.

CT scan and EUS play complementary roles in staging gastric cancer. CT scan is initially performed to detect local and distant metastases. Depending on institutional expertise, EUS may be considered for local staging. Laparoscopic staging may also be helpful in select patients. It is hoped that further improvements in these techniques will improve the ability to stage gastric cancer and thereby optimize patient treatment and outcome.

Superior mesenteric artery syndrome. Diagnostic criteria and therapeutic approaches.

The hospital records and radiographs of 44 patients diagnosed as having superior mesenteric artery syndrome were reviewed using strict clinical and radiographic criteria. Only six (14.6 percent) of the patients fulfilled these criteria, suggesting over-diagnosis of the disorder. An acute change in clinical status, such as an operation or complication of a medical disease, appeared to precipitate the superior mesenteric artery syndrome in these patients, all of whom had chronic debilitating diseases. In four of the six patients conservative therapy failed, and they required surgical decompression.

Diverging gastro-esophageal folds: an useful sign for detecting small hiatal hernias in the erect position.

Upright, double contrast films of the gastro-esophageal junction were reviewed in 30 patients with hiatal hernias and 30 normal controls. Patients with hiatal hernias demonstrated gastro-esophageal folds that converged above the diaphragm and diverged at or beneath the diaphragm on double contrast films of the esophagus. In the normal situation these folds were found to converge at or beneath the diaphragm. The origin and significance of this sign for the diagnosis of hiatal hernias in the upright position is discussed.

Gastrointestinal complications of spinal cord injury.

The incidence, nature, and radiographic features of gastrointestinal complications encountered in a group of 567 consecutive spinal-cord-injury patients are reported. Eighty-seven episodes of gastrointestinal complications developed in 63 (11%) patients. During the first month postinjury, these complications consisted of ileus, gastric dilatation, the body cast syndrome, peptic ulcer disease, and pancreatitis. More chronically these patients presented with fecal impactions, peptic ulcer disease, the superior mesenteric artery syndrome, hepatitis, amyloidosis, and the precocious appearance of diverticulosis, hiatus hernia, and gastroesophageal reflux. Radiographic findings were diagnostic in the majority of cases and aided in the early diagnosis of these potentially life-threatening complications.

Unilateral enlargement of the internal auditory canal: a developmental variant.

Marked asymmetry of the petrous pyramids as seen on plain skull roentgenograms is reported in 3 patients with no clinical findings related to the region of the cerebellopontine angle. Polytomograms of the enlarged internal auditory canal in these patients demonstrated in intact crista falciformis and absence of cortical destruction. These roentgenographic features suggest that the asymmetry represents a developmental variant. When contrast enchanced computed tomography fails to demonstrate an abnormality in asymptomatic patients with an enlarged internal auditory canal, it is unnecessary to proceed with further neuroradiological study.

Sphenoid sinus mucoceles presenting as intracranial masses on computed tomography.

Two cases of mucocele of the sphenoid sinus that presented as sellar and parasellar masses on computed tomography (CT) are presented. One mucocele was isodense while the other was hyperdense (100 Hounsfield units). Neither lesion demonstrated contrast enhancement. By delineating the total extent of the lesions, CT facilitated pre-operative diagnosis and surgical management.

Acquired immunodeficiency syndrome (AIDS) of the abdominal organs: imaging features.

The liver, spleen, biliary tract, pancreas, and kidneys are commonly affected by opportunistic infection, malignancy, and inflammatory disorders during the course of human immunodeficiency virus (HIV) infection. Clinical manifestations of solid abdominal visceral involvement are protean and usually nonspecific, but it is important to establish a specific diagnosis promptly in these often critically ill patients. This presentation reviews the cross-sectional imaging spectrum of HIV-associated lesions of these organs.

Staging of colorectal cancer.

CT, MR, and TRUS play complementary roles in staging CRC. Further improvements in these techniques will improve the accuracy of preoperative staging and thereby help optimize patient treatment and outcome.

Pelvic incidentalomas.

Recent advances in multi-detector computed tomography, magnetic resonance imaging, and ultrasound have led to the detection of incidental ovarian, uterine, vascular and pelvic nodal abnormalities in both the oncology and non-oncology patient population that in the past remained undiscovered. These incidental pelvic lesions have created a management dilemma for both clinicians and radiologists. Depending on the clinical setting, these lesions may require no further evaluation, additional immediate or serial follow-up imaging, or surgical intervention. In this review, guidelines concerning the diagnosis and management of some of the more common pelvic incidentalomas are presented.