Bernard S. Wolf

Endocardial cushion defects: Specific diagnosis by angiocardiography∗

Abstract 1. 1. The anatomy and embryology of endocardial cushion defects are reviewed. 2. 2. Angiocardiographic deformities of the left ventricular outflow region and of the mitral valve are described which we believe to be characteristic and diagnostic of endocardial cushion defects. This method appears to be the most accurate single diagnostic technic available for the identification of these lesions. 3. 3. This study is based on a review of 16 cases of cushion defects and over 200 left ventricular angiocardiograms in a wide variety of congenital cardiac disorders.

Ultrasonography of adrenal masses: usual features.

Gray-scale B-scan was successful in delineating adrenal masses in 40 patients, all confirmed pathologically. Two patients with extra-adrenal pheochromocytomas, two calcified cysts, and two patients with bilateral adrenal hyperplasia are demonstrated. The usual ultrasonographic features are presented in this paper; they correlated well with urographic, angiographic, CT, and pathological findings. The smallest mass demonstrated was an aldosteronoma (1.3 cm in size).

Segmental infarction of the small bowel.

Impairment of the blood supply to the intestinal tract produces a variety of pathologic changes which may be reflected in roentgen studies. In general, such circulatory disturbances are secondary to strangulating obstructions, as a volvulus or strangulated hernia, or primary, as a result of occlusion of the veins and arteries of the bowel by thrombi or emboli. In the majority of cases, these conditions constitute a surgical emergency requiring prompt intervention. There is a small group, however, in which short segments of small bowel become only partially devitalized instead of undergoing gangrene of the entire wall and perforation. In such an event, healing may occur and be followed by stenosis. The patient may then present the findings of intestinal obstruction of unknown etiology. Barium studies are usually performed for diagnostic purposes, and differentiation from other, particularly neoplastic, causes of obstruction becomes a problem. The purpose of this paper is to describe the roentgen findings i...

Linitis Plastica or Diffusely Infiltrating Type of Carcinoma of the Colon

The linitis plastica type of scirrhous carcinoma occurs most frequently in the stomach and is extraordinarily uncommon in the colon (1, 3, 7) or elsewhere in the gastrointestinal tract (1–3). In a series of 12,000 cases of carcinoma of the colon studied by Fahl, Dockerty, and Judd (2), 11 instances of this type were found, an incidence of less than 1 in 1,000. In an additional 80 cases in that series, scirrhous features were present in the lesion, but the gross appearance was not that of linitis plastica. Many cases reported as the primary linitis plastica type of carcinoma of the colon have been associated with previous long-standing chronic ulcerative colitis. In the series noted above, 3 of the 11 cases occurred in patients with that disease. Strictures due to benign fibrosis in the wall of the colon occur in a number of patients with chronic ulcerative colitis (4) and may perhaps precede the development of a scirrhous carcinoma. Other instances of linitis plastica of the colon originally thought to be...

Ultrasonography in ascites.

Ascites is usually not difficult to detect with ultrasonography because of its characteristic lack of echoes. However, minimal or lobulated collections of fluid or unusual distributions due to anatomical variations or associated pathological processes may create problems in diagnosis. Differentiation from an intraperitoneal abscess, hematoma, lymphocele, or cystic mass is of considerable clinical importance.

Ultrasonography of adrenal masses: unusual manifestations.

Forty patients with pathologically-proved adrenal masses, and two patients with extra-adrenal pheochromocytomas, were examined with gray scale B-scan. The authors describe unusual echo patterns of adrenal masses due to necrosis or hemorrhage, variations in the effects of large adrenal masses on surrounding organs and vessels, and the differential diagnosis. The complementary role of computed tomography is also discussed.

Simultaneous Cineradiographic-Manometric Study of the Distal Esophagus: Small Hiatal Hernias and Rings

Manometric features were correlated with roentgen configurations of the esophagogastric region in subjects with hiatal hernias and with rings by simultaneous cineradiographic and manometric study. The supradiaphragmatic pouch in small hiatal hernias was shown to have two functionally distinct components. Its upper portion (vestibule) had sequential contractile motor activity in response to swallowing. The lower portion was inactive and represented the true hernial sac. A weblike ring (Schatzki) or notches were often identified at the junction of these two segments. There was no peristaltic activity at or below this type of ring. A broad ring with contractile radiological behavior at the upper margin of the vestibule showed resting high pressure which fell on swallowing. This differed from the resting high pressure zone of normals in being shorter in length and showing an abrupt rather than gradual transition to contiguous pressures. Retrograde barium flow from hernial sac into the tubular esophagus was not seen when such a contractile A-ring was evident. Retrograde barium flow into the esophagus from the hernial sac occurred in those subjects not having a resting high pressure zone. Such reflux was delayed as long as the peristaltic wave persisted in the vestibular segment above the hernial sac. A constriction above the hernial sac during retrograde flow presumably represents a residual manifestation of the peristaltic wave, is transient, and is not associated with elevated resting pressure. The pressure inversion point was inconstant in its location in hiatal hernia subjects. It was often located at the site of the upwardly displaced high pressure zone, although a second pressure inversion point could be identified at the hiatal level on deep inspiration.

The diagnostic value of the deep cerebral veins in cerebral angiography.

Carotid angiography (1) has become an established and increasingly popular procedure in neuroradiology. For diagnostic purposes, most of the emphasis has been placed on changes in the arterial phases. This paper is presented to emphasize the importance of changes in the deep veins of the brain. With serial filming, the deep veins are regularly visualized from four to six seconds after injection. If films are taken at one-second intervals, the deep veins are usually seen in two successive frames. Our present procedure is to take seven films in eight seconds, since the intracranial circulation may be slow in the presence of increased intracranial pressure. Normal Anatomy The normal anatomy of the pertinent deep veins is represented in Figures 1–4. No attempt to describe it in detail will be made. Several venous tributaries seen only occasionally are not illustrated. These include: (1) a posterior epithalamic vein which appears to arise near the pulvinar and joins the internal cerebral vein a short distance ...

Feasibility of coronal views in computed scanning of the head.

With some models of computerized scanners, it is possible to obtain not only axial, but also coronal tomograms. This is feasible because a water bag is not used and limited tilting capacity is built into the gantry. The head is extended and the central ray directed perpendicularly to the base of the skull. The resulting views, orthogonal to the conventional axial views, furnish important complementary information.

Visualization of the Thyroid Gland with Computed Tomography

Computed tomography of the neck will demonstrate the thyroid gland particularly well after contrast enhancement. Lucent nodules within the thyroid can be demonstrated, but the attenuation numbers are not reliable enough to distinguish cystic from solid lesions with current techniques because of partial volume effects and motion artifacts.