Alfred S. Berne

The Various Causes of Scalloped Vertebrae with Notes on Their Pathogenesis

“Scalloping” is used to describe that change in the configuration of the vertebrae, in which there exists an exaggeration of the normal slight concavity of the dorsal surface of the body. Scalloping in association with a locally expanding mass in the spinal canal is well recognized. There are other less well known causes of this type of vertebral deformity. This paper will present a retrospective study in which examples of scalloping were collected from our files and from the literature and were classified according to the pathogenic mechanisms involved. Our aim is to bring a sense of order to a subject which is discussed in a rather fragmentary manner in the literature. Examples from the various groups will be illustrated, and hypotheses regarding the mechanisms of scalloping will be offered. In formulating a classification of scalloped vertebrae, we have taken into consideration the pathogenic mechanisms by which the configuration of bones may be altered. An abnormal configuration might result either pr...

Radiologic features of extraperitoneal effusions. An anatomic approach.

Abstract Criteria for radiological diagnosis of specific compartmentalization of extraperitoneal fluid and its possible sources were developed by (a) determining pathways of extraperitoneal fluid flow and establishing preferential routes of spread from various sites; (b) establishing fascial boundaries which direct and compartmentalize extraperitoneal fluid collections; and (c) defining the role of peritoneal reflections in the passage of exudates. The correlation of the distribution of fluid with the extraperitoneal fascial planes is based on cross-sectional planes derived from frozen cadavers, postmortem injection studies, and selected clinical cases in various disease states.

Rapid re-expansion of pneumothorax. A cause of unilateral pulmonary edema.

Two instances of unilateral pulmonary edema occurring as the result of rapid re-expansion of pneumothorax are described and illustrated. This type of pulmonary edema is preventable by gradual expansion of the lung collapsed by pneumothorax. If edema should occur, however, it resolves in five or six days without permanent sequelae.

Computed Tomography of the Subperitoneal Space: Demonstration of Direct Spread of Intraabdominal Disease

The direct spread of intraabdominal disease via peritoneal folds is clearly demonstrated with computed tomography (CT). This extensive network of peritoneal folds can be conceptualized as the subperitoneal space. These subperitoneal communications within the abdomen are described and demonstrated by CT scans and a schematic drawing. Direct spread of disease within and between abdominal compartments is illustrated with selected clinical cases stressing the CT imaging method.

Mechanism of direct spread of abdominal neuroblastoma: CT demonstration and clinical implications.

Neuroblastoma, a malignant tumor of neural crest origin, is the most common extracranial solid tumor in children. In 1971 Evans et al. introduced a clinical staging for neuroblastoma. Over sixty percent of patients present with neuroblastoma beyond stage I. Despite more aggressive therapy there has been only minimal improvement in survival.Since 1978, all patients with neuroblastoma have had CT scanning as part of their initial evaluation at our institution. Children with abdominal neuroblastoma beyond stage I form the basis of this report.Selected cases illustrating the permeative nature of neuroblastoma and the mechanism of direct abdominal spread by CT scanning are presented. The tumor originates in the retroperitoneum and spreads to the abdominal aorta where it gains access to the subperitoneal space via the celiac axis and superior mesenteric artery. These vessels course from the aorta to their ultimate destination within their peritoneal folds. These folds form the interconnecting space (subperitoneal space) between the retroperitoneum and the peritoneal organs.Such scanning is extremely sensitive in detecting neuroblastoma with early infiltration into adjacent tissues and contiguous spread through abdominal spaces. The clinical implications of the permeative nature of neuroblastoma and the mechanism of contiguous abdominal spread are discussed.

The Extraperitoneal Perivisceral Fat Pad: II. Roentgen Interpretation of Pathological Alterations

THE PURPOSE of this paper is to describe the roentgen manifestations of alterations of the normal anatomy of the extraperitoneal perivisceral fat pad and to emphasize that both intra- and extraperitoneal pathologic processes can affect the e. p. f. p. Intraperitoneal Disease A. Fluid: Intraperitoneal fluid in the upper abdomen frequently manifests itself radiologically by collecting adjacent to the properitoneal fat line as a linear density, displacing the colon medially and thinning the properitoneal fat. This shadow has been called the “flank stripe” (5). In addition, the medial margin of the “hepatic angle” may be lost (Fig. 1). What is the explanation for the loss of the hepatic angle by intraperitoneal fluid if the shadow of the hepatic angle is cast by the livers contrasting with extraperitoneal Iat?3 The great pliability of the e. p. f. p. explains this finding. The intraperitoneal fluid fills the peritoneal recess about the posterior inferior portions of the liver, widening and blunting it. The f...