Andrew M. Fried

Abdominal CSF pseudocyst secondary to ventriculoperitoneal shunt: diagnosis by computed tomography in two cases.

Two cases are presented in which the preoperative diagnosis of abdominal cerebrospinal fluid pseudocyst was made by computed tomography (CT). The collection can be well outlined by this method, and measurement of density values characterizes the contents as a water density; the relationship of portions of the shunt catheter to the pseudocyst can be demonstrated as well. It is suggested that, in a patient with a ventriculoperitoneal shunt who develops abdominal signs or symptoms. CT can provide the definitive diagnosis of this entity.

Pseudocyst formation in hereditary pancreatitis

The previously estimated incidence of pseudocyst formation in hereditary pancreatitis is approximately 10%. Our experience in nine patients with hereditary pancreatitis yielded five surgically documented pseudocysts and three additional patients with radiographically documented mass effects. Recent studies have shown a 20% spontaneous regression rate for pancreatic pseudocysts (of all etiologies), when evaluated by B-mode ultrasonography; our experience suggests that the incidence of pseudocyst formation in hereditary pancreatitis is considerably higher than previously suspected. Ultrasonography is thought to be an excellent method for diagnosing this entity, of evaluating mass effects identified on radiographic studies, and of providing sequential evaluation of pseudocysts treated surgically or conservatively.

Abdominal CT scans in patients with blunt trauma : low yield in the absence of clinical findings

This study undertook to determine the yield of abdominal CT scans ordered only because the patients sensorium was decreased or general anesthesia was planned. The abdominal CT scans and hospital charts of 191 consecutive patients examined following blunt trauma were reviewed with respect to clinical indications prompting the study. In 143, some clinical or laboratory justification was in evidence. In this group, 55 patients (38.5%) were found to have trauma-related pathology at CT scan. In 48 patients, no clinical or laboratory suggestion of abdominal pathology was evident. Instead, the primary indications for ordering the CT scan were decreased sensorium (28 cases), the planning of general anesthesia for orthopedic procedures (8 cases), and a variety of non-abdominal-trauma-related reasons. In this group, only a single positive finding was identified (small pneumothorax), and in no case was the clinical course altered by findings at abdominal CT scan. Performance of abdominal CT scans without clinical or laboratory evidence of trauma, merely because of decreased patient sensorium or prophylactically prior to general anesthesia for non-abdomen-related surgery, is an extremely low yield study and should be discouraged. In the current study, no significant abdominal pathology would have been overlooked by omission of such scans. Similar findings have been reported in children. To our knowledge, this is the first such report in a largely adult population.

Distribution of the bulk of the normal placenta: Review and classification of 800 cases by ultrasonography

A series of 800 ultrasonographic placentographies is reviewed and categorized by the location of the main bulk of the placenta. It represents, to our knowledge, the first such study of the undisturbed placenta and demonstrates a remarkably even distribution with frequent overlapping of more than one uterine sector. A simple form of categorization is presented and the clinical implications and value of ultrasonography are underscored.

Hydronephrosis with Ureteral Valve: Diagnosis by Ultrasonography and Antegrade Pyelography

A case of massive hydronephrosis secondary to a ureteral valve was discovered upon evaluation of mild trauma. The orderly diagnostic studies, including ultrasonography and antegrade pyelography, led to the correct diagnosis and appropriate therapy. Ultrasonography as a diagnostic tool in urology is discussed and characteristics of the 18 cases of ureteral valves reported to date are reviewed.

Computed tomographic evaluation of para-aortic hematoma following translumbar aortography.

Computed tomography provides an objective means of studying needle passage and para-aortic hematoma formation following translumbar aortography (TLA). CT scans from the puncture site to the aortic entry site were done in 13 patients before and after catheter removal to evaluate the incidence and extent of hematoma formation. Eleven (87%) demonstrated para-aortic hematomas following TLA; 8 were confined to the left para-aortic area and 3 involved both sides. The catheter passed through the left kidney in one patient; however, no hematoma was observed.

High Retroperitoneal Lymphocele: Unusual Clinical Presentation and Diagnosis by Ultrasonography

A case of a mid lumbar lymphocele secondary to retroperitoneal lymphadenectomy for testicular carcinoma is described. The clinical picture was unusual and confusing in that the symptoms were gastrointestinal in nature. Ultrasound provided the diagnosis and guidance for aspiration. Although the most common operative source of lymphocele formation appears to be the pelvic lymphatics similar collections may arise from para-aortic and renal hilar dissections and produce unusual manifestations. Ultrasound is of established value in such cases.

Adaptation of multiformat film holder to real-time ultrasound.

A method is described for adaptation of a multiformat film holder to a free-standing real-time imaging unit. No additional electronics are necessary for modification.