Chest radiographic-pathologic correlation in adult leukemia patients.

A radiographic-pathologic correlation study of adult leukemia patients was conducted to determine the frequency and radiographic appearance of leukemic involvement and related complications within the chest. One hundred thirteen autopsy protocols were examined. Radiographic correlation was obtained in 60 of these cases. Autopsy pulmonary findings included hemorrhage in 74% of the cases, infectious infiltrates in 67%, edema or congestion in 57%, and leukemic infiltration in 26%. Only 5% of the chest radiographs were normal. Alveolar or interstitial abnormalities were identified in 90%, pleural effusion in 40%, and lymphadenopathy in 17%. Correlation demonstrated pulmonary infection to be by far the most common cause of radiographic opacity. Because of its frequent occurrence, high associated mortality, and potential reversibility, pneumonia must always be considered first in the differential diagnosis of radiographic opacity in these patients.

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 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.

Calcification in pulmonary metastases.

A large variety of neoplasms can produce calcified lung metastases. Three unusual examples are presented and the relevant literature is reviewed. Each case involves a neoplasm not previously reported to produce calcified lung metastases: malignant mesenchymoma, fibrosarcoma of the breast, and medullary carcinoma of the thyroid. The sarcomas are reported in the literature to develop calcified lung metastases are osteogenic sarcoma, chondrosarcoma, synovial sarcoma, and giant cell tumour. Among carcinomas, the papillary and mucinous adenocarcinomas are the histological types most likely to develop calcified lung metastases. The metastases of a number of other tumours have calcified after antineoplastic therapy. Calcification in metastases arises through a variety of mechanisms: bone formation in tumour osteoid, calcification and ossification of tumour cartilage, dystrophic calcification and ossification of tumour cartilage, dystrophic calcification and mucoid calcification. Since calcified lung metastases can strongly resemble granulomas or hamartomas, a reasonable suspicion of malignancy is necessary when evaluating calcified pulmonary nodules.

Catheter drainage of the left posterior subphrenic space: a reliable percutaneous approach.

Catheter drainage of left posterior subphrenic collections can be difficult because of lack of a safe access route. We have found that manual compression of the soft tissues of the posterior left flank can create a safe route for catheter drainage, which otherwise would not be possible. This report describes the technique we have used successfully in 8 cases.

Osteosarcoma: role of CT in limb-sparing treatment.

The computed tomographic (CT) examinations of 17 patients undergoing evaluation for limb-sparing treatment of osteosarcoma were evaluated. In all cases information from CT directly affected the operative approach. The CT findings that helped in planning the operative approach included determination of intramedullary extent and evidence of "skip" metastases, direct extension into an adjacent joint, and neurovascular compromise. Performing CT of the affected bone at 1-cm intervals from the joint above through the joint below and including the contralateral side in the field of view allow precise localization of findings that can direct the operative approach. Close and contiguous scanning intervals allow identification of small intramedullary "skip" metastases that affect the resection margins.

Computed tomography of neutropenic colitis.

Four patients developed neutropenic colitis as a complication of acute leukemia (three) or aplastic anemia (one). On computed tomography (CT), neutropenic colitis was characterized by cecal wall thickening (four) and pneumatosis (one). Intramural areas of lower density presumably reflected edema or hemorrhage. Clinical improvement and return of adequate numbers of functioning neutrophils coincided with decrease in cecal wall thickening on CT. Prompt radiologic recognition of this serious condition is crucial, since surgical intervention is probably best avoided.

The plain abdominal radiograph in acute gastrointestinal graft-vs.-host disease.

The plain abdominal radiographs of 28 patients with acute gastrointestinal graft-vs.-host disease (GVHD) were examined to determine the plain radiographic findings associated with this disorder. These findings, in order of decreasing frequency, included air-fluid levels, bowel wall/mucosal fold thickening, gasless abdomen, bowel dilatation, pneumatosis intestinalis, and ascites. When a number of these findings are present, the plain abdominal radiographs may be sufficiently characteristic to suggest gastrointestinal GVHD. Differentiating acute gastrointestinal GVHD from small-bowel obstruction is often of major clinical importance. Fortunately, the bowel gas pattern in acute gastrointestinal GVHD rarely suggests obstruction and, thus, bowel obstruction can usually be excluded on the basis of plain radiographs alone.

Liver allograft transplantation: postoperative CT findings.

The CT findings in the abdomen after liver transplantation as seen on 72 examinations in 23 allograft recipients are described. CT was most useful in the evaluation of the gross structural integrity of the allograft and in the detection of extrahepatic fluid collections. Low-density foci within the allograft parenchyma were seen in 10 patients (43%) and were associated with infarction and necrosis, infection, malignancy, and rejection. Localized extrahepatic fluid collections (hematomas, bilomas, and seromas) were present in 16 patients (70%); four of the focal fluid collections detected by CT were infected. Since the nature of these fluid collections could not always be determined by CT characteristics, fine-needle aspiration was sometimes required for a specific diagnosis. Prominence of the portal structures was associated with previous or ongoing episodes of rejection in eight of nine patients, likely reflecting increased resistance to portal flow. CT occasionally showed low, dense, and calcified thrombi in the donor aorta and inferior vena cava. CT also showed biliary obstruction in four patients (17%) without identifying its cause. CT is a noninvasive means of imaging the hepatic allograft recipient; providing data on the hepatic parenchyma, vasculature, and biliary system; and identifying the presence of intraabdominal fluid.