Arteriography and interventional therapy for diseases of the hand.

Because the vessels of the hand are small and very responsive to stimuli, arteriography of the hand requires painstaking technique, temperature control, and sometimes vasodilator administration to produce sufficient radiographic detail. Twenty-five patients underwent arteriography of the hand, which was performed from a transfemoral approach to evaluate pathologic changes and the possibility of interventional treatment. Production of high-quality images by means of attention to technical factors particular to the hand permitted recognition of radiographic detail essential to diagnosis. Twelve patients had a history of trauma, and five patients had congenital lesions. In eight patients, atherosclerotic, vasospastic, or embolic arterio-occlusive disease was diagnosed. Interventional radiologic procedures such as thrombolysis, therapeutic embolization, and percutaneous transluminal angioplasty are important adjuvant or primary management options. Angiography of vascular hand lesions can yield high-quality diagnostic images when technical factors and physiologic variables are maximized. Differentiation between traumatic, congenital, and occlusive lesions is then possible.

Portal system thrombosis after splenectomy for neoplasm or chronic hematologic disorder: is routine surveillance imaging necessary?

PURPOSE: This study was undertaken to assess the frequency and sequelae of portal system thrombosis (PST) after splenectomy in patients with cancer or chronic hematologic disorders and to determine whether routine surveillance imaging for this potential complication is warranted. METHOD: The radiology reports of 203 consecutive patients with cancer or chronic hematologic disorders who underwent splenectomy between January 1990 and January 1997 were reviewed. Imaging examinations and medical records were reviewed for those in whom PST was found after splenectomy. RESULTS: One hundred twenty-three patients (60.6%) underwent CT (n = 88), sonography (n = 10), or both (n = 24) after splenectomy; one other patient underwent MRI. Twelve of these patients (9.8%) had thrombosis of the splenic, portal, and/or superior mesenteric veins. Their underlying diseases were myelofibrosis/ myelodysplastic syndrome (n = 8), lymphoma (n = 3), and leukemia (n = 1). At follow-up imaging (obtained in 10 of the 12 patients), PST had resolved (n = 5), worsened (n = 2), improved (n = 1), remained unchanged (n = 1), or resulted in cavernous transformation of the portal vein (n = 1). Nine of 12 patients were symptomatic. No patient died of PST. CONCLUSION: PST was an uncommon and typically unsuspected finding after splenectomy in this patient population, and no serious sequelae of PST were found. Routine surveillance imaging for PST after splenectomy does not seem warranted, but in symptomatic patients (particularly those with myelofibrosis/myelodysplastic syndrome), a high clinical suspicion and a low threshold for obtaining imaging examinations are needed.

Gallbladder cancer: can ultrasonography evaluate extent of disease?

This study reviews the spectrum of sonographic findings in patients with gallbladder cancer, attempts to determine if sonography can identify patients with potentially resectable disease, and emphasizes the limitations of ultrasonography in the evaluation of -gallbladder cancer. Thirty-five consecutive patients with histologically proven gallbladder carcinoma who had preoperative abdominal ultrasonography and surgery were identified. Involvement of the gallbladder and gallbladder fossa, metastases, bile ducts, portal vein, and adjacent lymph nodes was assessed sonographically. The extent of disease and staging as revealed by sonography was compared to operative and surgical pathologic findings. Masses in the gallbladder or gallbladder fossa were present at surgery in 26 patients; 22 (85%) of these masses were shown by sonography. Sonography identified six (67%) of nine cases of pathologically confirmed liver metastases, 11 (79%) of 14 cases of bile duct involvement, and two (67%) of three cases of portal venous involvement by tumor. Sonography revealed lymph node metastases in only five (36%) of 14 patients. None of the 12 cases with peritoneal metastases was identified sonographically. By surgical staging 16 (46%) patients had potentially resectable disease (stage III or less), and 19 (54%) patients had unresectable stage IV disease. Sonography correctly identified 15 (94%) of 16 patients with potentially resectable disease and seven (37%) of 19 patients with advanced disease. Twelve patients with advanced disease were under-staged: nine had peritoneal metastases, two had liver metastases, and one had celiac adenopathy, which was not shown by sonography. In conclusion, sonography is reliable in the detection of a primary gallbladder mass or of local extension of tumor into the liver. However, sonographic findings do not accurately reflect the full extent of disease, and sonography is particularly limited in the diagnoses of metastases to the peritoneum and lymph nodes.