Benjamin Felson

Intramural Hematoma of the Duodenum A Diagnostic Roentgen Sign

Intramural hematoma of the intestine is a condition in which, spontaneously or as a result of trauma, a localized collection of blood extravasates into the subserosal and interstitial tissues of the intestine. It has been described on a number of occasions as an unexpected finding at laparotomy or at autopsy, but a correct preoperative diagnosis has not been recorded. In 1948 Liverud (9) reported a case involving the jejunum adjacent to the ligament of Treitz, and included the only detailed roentgen description in the literature. We have encountered 4 cases, in each of which the duodenum was predominantly affected. The roentgen findings, similar to those in Liveruds case, are so distinctive that we believe them to be pathognomonic of intramural hematoma of the duodenum. Report of Cases Case I: G. D., an 18-year-old male, was admitted to Cincinnati General Hospital on Nov. 17, 1951, seven hours after being struck in the abdomen during a football game. He was momentarily prostrated by the injury, but felt ...

Anomalous Right Subclavian Artery

Anomalous right subclavian artery, originating as the last vessel from the aortic arch, is one of the commonest anomalies of the great vessels. Anatomists have been familiar with this condition for more than two centuries, yet few clinicians are aware of its existence. Despite its frequency and the ease with which it can be detected roentgenologically, the correct diagnosis is seldom made during life. This is due, in part, to the fact that the anomaly is usually asymptomatic. Occasionally, however, severe symptoms may develop and progress to a fatal outcome. This anomaly has assumed greater significance with the advent of the surgical approach to the treatment of congenital malformations of the heart and great vessels. Gross (12), in 1946, successfully ligated an anomalous right subclavian artery. Since that time he has surgically cured 4 additional patients with symptoms related to this cause (13). Blalock (5) encountered the anomaly five times during operations on patients with the tetralogy of Fallot, ...

Localization of intrathoracic lesions by means of the postero-anterior roentgenogram; the silhouette sign.

With the rapid advances in thoracic surgery, segmental localization of pulmonary disease has assumed greater importance. This has required that the roentgenologist use any method which may serve to localize disease processes within the thorax. The earliest method of localization was by means of stereoscopic films. Later, combined postero-anterior and lateral roentgenograms were employed. More recent refinements in this direction have included oblique views, laminagraphy, bronchography, etc. It is often helpful, if possible, to determine the exact location of a pulmonary density from the postero-anterior film alone. The following criteria, currently utilized, are of distinct value in such localization. An area of radiopacity involving the extreme apex of a lung is almost invariably situated in an upper lobe. One which involves a pulmonary costophrenic angle usually lies in a lower lobe. An abnormality in the right upper lung field, the lower border of which is delineated by the minor fissure, lies in the r...

The roentgen diagnosis of disseminated pulmonary alveolar diseases

Abstract The roentgen signs of diffuse alveolar involvement differ considerably from those seen with other sites of disseminated pulmonary involvement. This alveolar pattern can usually be identified. The individual causes of disseminated alveolar disease have been grouped and classified. By recognizing this roentgen pattern, one can predict with high accuracy the presence of alveolar disease and then, by utilizing the classification, logically approach the differential diagnosis of a major group of diffuse pulmonary diseases.

Acute miliary diseases of the lung.

The presence OF disseminated miliary lesions in the lungs, demonstrable on the chest roentgenogram, is of frequent occurrence and is seen in a wide variety of diseases. More than 80 conditions capable of producing this appearance have been recorded (1–3). Such a long list of possibilities makes it extremely difficult to establish a clinical diagnosis in a given case, and any lead obtainable from the roentgenogram is of considerable help. For instance, roentgen evidence of associated enlargement of the hilar and mediastinal nodes, pleural involvement, or cardiac abnormality may suggest one or another etiology. Some writers have considered differences in sharpness, configuration, size, number, and distribution of the individual miliary nodules helpful in differential diagnosis. An approach which has proved particularly useful in this institution, but which has not been emphasized in the literature, is the observation of change in the roentgen findings—specifically, the rate of progression or regression of t...

Noninfectious Necrotizing Granulomatosis

In 1936, and again in 1939, Wegener (26, 27) reported a syndrome which has aroused widespread interest among clinicians, pathologists, and, more recently, radiologists. His 3 cases, which he designated rhinogenous granuloma, presented a severe destructive granulomatous rhinitis associated with ulcerations in the upper respiratory tract. Pulmonary and renal involvement were also prominent features. The illness terminated fatally within seven months after onset of symptoms. Pathologically, the condition was characterized by the presence of a peculiar necrotizing granulomatous process in the upper respiratory tract and sometimes in the lungs, focal glomerulonephritis, and a more or less generalized angiitis which in many respects resembled periarteritis nodosa. Similar cases had been reported earlier by Klinger (15) and by Rossle (22). Ringertz (19) subsequently reported a case with pulmonary involvement but without nasal or upper respiratory lesions. The nasal and facial manifestations of Wegeners cases we...

Ruptured anomalous right subclavian artery: Aneurysm or diverticulum?

A SURPRISING number of cases of ruptured aneurysm of an anomalous RSA have been reported in the literature’

Roentgen findings in obstructed diaphragmatic hernia.

surprising because far too many of them occur at this odd site, and surprising also because most authors have ignored the frequency in this very location of the so-called Kommerell diverticulum, a persistent root of the fourth RAA from which the anomalous RSA arises. The lesions illustrated radiographically in these reports do look aneurysmal, but so do aortic diverticula.’ My reasons? It has the gross and histologic appearance of an aorta, it’s common, and this is where it resides. This concept may be important for the management of the lesion. Some intact “aneurysms” have been resected to prevent rupture, that in actuality seldom occurs.‘-* However, a diverticulum may become truly aneurysmal, enlarging with time and even undergoing thrombosis or perforation, thus requiring surgery. To add to the complexity of the problem, a true aneurysm may arise in an anomalous RSA that does not have a diverticular source. It too needs surgical consideration.

Aortic Thrombosis as a Cause of Hypertension: An Arteriographic Study

As one reviews the rather extensive literature concerned with obstructed diaphragmatic hernia, it becomes evident that there has been considerable difficulty in making this diagnosis. Yet our own experience indicates that it can be promptly established roentgenologically if certain basic facts and principles are kept in mind. The importance of early recognition of this condition cannot be overemphasized, since strangulation and other serious sequelae so often supervene that in untreated cases the mortality approaches 90 per cent (19). Obstruction may complicate any type of diaphragmatic hernia (3, 20). It is relatively rare, however, in right-sided traumatic hernia since the liver generally prevents the gut from entering the chest (14). The present discussion will be limited to hiatal and traumatic hernia of the left hemi-diaphragm, the two most common types, but the roentgen signs to be described are applicable as well to hernias through the other orifices. Obstructed diaphragmatic hernia is not rare. Su...

Uncomplicated Dextroversion of the Heart

Goldblatt and his co-workers (1) discovered that constriction of one renal artery caused transient systemic hypertension in dogs and prolonged hypertension in other animals. Complete occlution of the renal artery did not produce this effect. Constriction of both renal arteries resulted in persistent hypertension, as did constriction of one renal artery after removal of the opposite kidney. It was also shown that hypertension could be produced by constricting the aorta proximal to the renal arteries but not by compression applied distal to these vessels. Excision of the ischemic kidney following unilateral constriction resulted in disappearance of the hypertension. Since these classical experiments, many cases of hypertension associated with constriction of a main renal artery have been reported. Among these a variety of arterial lesions has been found; all appear to have in common partial interruption of the blood flow to a kidney. These cases represent the human counterpart of Goldblatts animal experime...