Idiopathic renal arteriovenous fistula. Spontaneous closure.

A large and symptomatic idiopathic renal arteriovenous (AV) fistula closed over a two-year period of clinicoradiologic observation. This feature of idiopathic renal AV fistulas has not been reported previously, to our knowledge. If the presenting symptoms permit nonintervention, not only the trauma-related but also the idiopathic renal AV fistula can be conservatively managed and may heal spontaneously.

Computed tomography and sialography of chronic pyogenic parotitis.

We performed Computed Tomography (CT) immediately following, or simultaneous with, conventional sialography on a group of 45 patients with parotid gland swellings over a two-year period. Tumours occurred in eight, sarcoidosis in 22, actinomycosis in two and chronic pyogenic parotitis in 13 patients. In the latter group, there were two cases of bilateral disease, for a total of 15 glands. The sialographic and the combined CT-sialographic features were retrospectively analysed. In all cases, ductal pathology was more severe in the main and proximal branches, was better demonstrated on conventional sialography and was diagnostic in 10/14 glands (71%). CT-sialography was the superior modality in the evaluation of the gland parenchyma and the adjacent structures, demonstrating diagnostic features of infection in 8/14 glands (57%). However, a combination of both modalities presented a consistent pattern of infection in all cases, distinctive from tumours and sarcoidosis. CT-directed aspiration was performed on the four glands which were equivocal on conventional sialography, and two of these underwent a simultaneous aspiration-irrigation with antibiotics. Although this report is based on a limited experience, CT-sialography with aspiration appears to be an interventional radiological alternative to the traditional diagnostic superficial parotidectomy. Ultrasonography (two cases) and nuclear scintigraphy (one case) added little useful information in chronic pyogenic parotitis.

Sarcoidosis of the parotid gland.

The clinical and radiological features of parotid-gland sarcoidosis in 22 patients are presented. This occurred in association with systemic disease as painless, diffuse and nonnodular parotid swelling. Conventional sialography usually demonstrated normal proximal ducts, a few fragile distal ducts and non-specific parenchymal nodules. Computed tomography, with or without simultaneous sialography, defined and characterised such nodules and demonstrated normal periparotid anatomy. Sialography contributes little additional information to thorough clinical examination in non-nodular or multinodular glands. However, solitary nodules appear to be better investigated by sialography, CT and CT-guided aspiration, thereby allowing diagnosis and direct medical therapy and avoiding surgery. Ultrasonography and nuclear scintigraphy were of little value in this study.

Splenic abscess on ultrasonography.

The characteristic sonographic features in 32 splenic abscesses (25 of which were retrieved from the world literature) were splenomegaly, associated with an-or hypoechoic masses of different sizes and shapes, demarcated by irregular walls, containing echogenic foci of variable intensity and demonstrating little or no sonic through-transmission. Although these splenic features are not pathognomonic for abscesses, they can be correlated with other incidental abdominal sonographic findings and the presenting clinical symptoms, can direct percutaneous needle punctures and can enable a prompt diagnosis. Immediate surgery is usually curative, and is necessary to improve the high mortality rate in untreated cases.

The superior mesenteric artery syndrome in pregnancy: a case resulting in recurrent pregnancy loss.

The Superior Mesenteric Artery (SMA) syndrome was the underlying cause of severe gastrointestinal symptoms in a patient with recurrent pregnancy loss. Following a surgical transposition of the duodenum, two normal pregnancies were carried to term. This is the first report of the SMA syndrome in pregnancy, to our knowledge.

Volvulus of the stomach: an African series and a review.

A radiological diagnosis of gastric volvulus (GV) was made in 11 of 576 consecutive upper gastrointestinal series at the University of Benin Teaching Hospital, Nigeria, over a two-year period. The clinical symptoms were thoracico-abdominal in three and abdominal in eight; these cases were evaluated as acute in three, acute upon chronic in two, and chronic in six. There was a significant delay in the diagnosis in all cases (except a neonate in the series), and no case was diagnosed on clinical grounds alone.THE PREDISPOSING FACTORS (EXCEPT THE CLINICAL MISDIAGNOSIS OF THE NEONATE) IN SIX OF THE SEVEN CASES THAT CAME TO SURGERY WERE: diaphragmatic hernia and perigastritis (left lung abscess, thoracic empyema), arteriomesenteric compression of the duodenum in pregnancy (peptic ulcer), splenomegaly (hepatosplenomegaly, ascites, esophageal varices), previous gastrojejunostomy (stomal ulcer, left subphrenic abscess) and two cases of intestinal malrotation with mesenteric abnormalities (small bowel obstruction in one and duodenal atresia in the other). In one idiopathic case, gastric outlet obstruction was clinically suspected prior to surgery. Thus, the putative rarity of GV in black Africans is not supported by this experience.Gastric volvulus is a clinico-radiologic entity that may present with a confusing thoracico-abdominal symptom complex. A greater awareness of the radiologic features is quintessential to an expeditious and usually successful surgical management that will avoid potentially serious complications. Negative surgical findings do not exclude GV as the underlying cause of acute abdomens necessitating emergency laparotomies.

Radiological management of obstructive jaundice.

Percutaneous transhepatic biliary drainage (PTHBD) is a new interventional radiologic procedure that can be applied in the management of malignant or benign biliary obstruction. PTHBD can be (1) retrograde, whereby bile is drained externally through a catheter and collected in a bag; (2) antegrade, whereby the obstructing lesion, usually a carcinoma of the pancreas, is bypassed with a catheter and bile is drained internally into the duodenum; or (3) a combination of both. PTHBD may be a definitive palliative procedure or a preoperative biliary decompressive modality when subsequent surgery or radiation therapy is planned. The experience at Howard University Hospital with this modality is reviewed; its indications, contraindications, and complications are discussed; and a limited review of the literature is offered. With the increasing incidence of pancreatic carcinoma in our patient population, PTHBD is bound to play an increasing role.

Ultrasound contribution to the diagnosis of neonatal hydrometrocolpos with proximal vaginal atresia.

The value of ultrasound examination in a case of neonatal hydrometrocolpos is presented. Ultrasound proved the pelvic origin and the cystic nature of the mass, determinations essential to a correct diagnosis.

Multifocal defects and splenomegaly in sarcoidosis: a new scintigraphic pattern.

Sarcoidosis involves the spleen in a significant percentage of patients afflicted with this disease. The most commonly applied modality for studying such patients is the (99m)Tc-sulfur colloid scan. Different patterns have been recognized: "normal" spleen and nonspecific splenic enlargement, with or without focal areas of photon deficiency, which was thought to represent an infarction in a previous report. We have encountered two patients showing splenomegaly and multifocal photon deficiencies secondary to sarcoid granulomata. These cases are presented to inform clinicians of a new pattern. Our patients were managed with systemic corticosteroids and palliation of pain. If symptoms persist or worsen, splenectomy may be necessary to avoid spontaneous rupture. An abbreviated differential diagnosis of the enlarged spleen with multiple focal defects is discussed.

Ameloblastomas of the jaws: radiological diagnosis and follow-up.

Eleven of 57 tumours and cysts (19 per cent) seen at two major centres over a 4-year period were ameloblastomas, primary in eight and recurrent in three. Computed Tomography (CT) was the most sensitive imaging technique for detecting ameloblastomas. The radiological features were distinctive maxillary and mandibular pathology in primary cases and soft-tissue, maxillary sinus and asymmetrical deep tissue involvement in both primary and recurrent ameloblastomas. Following surgery and pathological confirmation, serial scans were combined with periodic clinical re-evaluation. We identified clinically occult recurrences in two cases and confirmed a clinically-suspected recurrence in one on the basis of the CT findings. Our protocol appears efficacious and is suggested for the necessary long-term follow-up in all pathologically verified ameloblastomas.

Ultrasonography of the prostate: a preliminary report from Nigeria.

Suprapubic transabdominal prostatic sonography was performed at two Nigerian centers over the past year. All abnormal glands were found enlarged. Capsular, periprostatic and extra-organ features helped to segregate carcinomas from benign diseases. Gland shape and internal texture were less useful criteria. Prostatic sonography has great promise in developing and fragile economies, where other efficacious and contemporary imaging modalities are unaffordable.

Serendipity in cholangiography.

Seventeen of 107 consecutive direct cholangiography demonstrated serendipitous and unusual but significant contrast collections. The indications for and routes of cholangiography, correlative imaging procedures and outcome were retrospectively analysed. There was 6 bilomas, 3 aberrant bile ducts, 3 hepatic and 3 subphrenic abscesses and 2 gastrobiliary fistulae. Other contrast deposits were intra, perivascular, paraductal, interstitial and gastric reflux. While cholangiography cannot be proposed as the primary imaging modality in any of the above entities, the described incidental but significant cholangiographic features should be recognised, to optimize the total diagnostic yield (particularly in centres in developing economies, where cross-sectional imagers are scarce), redirect diagnostic endeavours to the real source of patients' problems, and discriminate normal and procedure-related from concurrent pathological accumulations, which may require specific therapy.

The left subphrenic crescent sign in direct cholangiography.

Left subdiaphragmatic collections of contrast medium were demonstrated in three patients during cholangiography. All the patients had undergone previous surgery for either biliary, gallbladder or pancreatic disease. The shape of the collections was crescentic and the underlying abnormality was an anterior subdiaphragmatic abscess. Left subphrenic abscesses should therefore be considered when crescentic left subphrenic accumulations of contrast medium occur during cholangiography.

Percutaneous transhepatic biliary drainage. Series with a technical note.

Barium duodenography was performed simultaneously with percutaneous transhepatic cholangiography in 11 patients with failed transhepatic visualisation of the duodenum prior to percutaneous transhepatic biliary drainage (PTHBD). The advantages of this modification, not only to guide PTHBD but also in percutaneous tumour biopsy and coeliac gangliolysis, are discussed with particular reference to developing economies, where newer cross-sectional imaging modalities are not available. There were no complications related to the duodenography.

Grey scale ultrasonography of the thyroid gland, Nigeria.

Thyroid ultrasonography was performed on a combined series of 108 patients over a four-year period. Ultrasonography enabled superb visualisation of the neck, specifically the thyroid, and discriminated solitary from diffuse thyroid abnormalities and segregated these into cystic, solid or 'complex' patterns. Sonographic-pathological correlation was obtained in 38 cases, consisting of 14 follicular adenomas, 11 goitres, 3 Hashimoto thyroiditis, 6 colloid cysts and 4 carcinomata; the clinical course confirmed 11 cases of Graves' disease for a total of 49 confirmed cases. The sonographic patterns lack histological specificity; however, a pattern recognition approach can be developed to better select patients for surgery. Such an approach appears suitable in tropical Africa, where radionuclide imaging may not be available. Diagnostic ultrasound is affordable, versatile and efficacious and without any known biological risks. A plea is made for its increased availability.

The management of acute laryngeal trauma.

A case report is presented illustrating the key points in the diagnosis and management of acute laryngeal injury. All patients with a history of injury to the head, neck, or chest should be assessed for possible laryngeal injury. The diagnosis requires a high index of suspicion. Computed tomography (CT scan) of the larynx is strongly advocated as the most important diagnostic tool. The goals in management are airway assurance and voice preservation. Prompt diagnosis will insure timely management and prevent early demise or complicated secondary corrective procedures.

Computed tomography of the calvarium: a prospective study.

Retrospective analysis of high-resolution raw scanning data was prospectively applied in the evaluation of lesions of the scalp and the calvarium over a 12-month period. The spectrum of abnormalities identified and the impact of CT on both diagnosis and management of 25 patients are presented. Metastases and traumatic lesions were excluded. CT was useful in both diagnosis and subsequent patient management.

Sonographic evaluation of jaundice in Benin-City, Nigeria. A preliminary report.

We performed sonographic evaluations on 14 jaundiced patients over a six months period. Medical jaundice was correctly diagnosed in three, as confirmed by the subsequent clinical course. Sonographic features of surgical jaundice were identified in the remaining 11 cases, five of which were confirmed through either percutaneous transhepatic cholangiography, surgery and pathology or both. Sonography is efficacious in the work-up of jaundice; since the technique is affordable and versatile, it is particularly relevant in developing economies where available resources are limited.

Computed tomography of adult colonic intussusception: clinical and experimental studies.

The CT features of a case of adult ileocolic intussusception and of experimentally induced ileocolic, cecocolic, and colocolic intussusceptions are presented. Both the clinical and experimental cases demonstrated (1) "target" masses with enveloped, eccentrically located areas of low density and (2) interspersed low- and high-density stripes within the intussusception producing a "layered" or "stratified" pattern. This layered pattern of abdominal masses may be characteristic of intussusceptions regardless of location.