Bhargavi K. Patel

Neutropenic colitis: Evaluation with computed tomography

The computed tomography findings of 10 patients with neutropenic colitis are described and illustrated. Seven of these patients had leukemia, one had lymphocytic lymphoma, and two had systemic lupus erythematosus. All patients had colon wall thickening which was either isodense with the normal bowel tissue or showed areas of intramural low density. Air in the thickened bowel wall was seen in six patients. These computed tomography findings in neutropenic patients with fever, abdominal pain, and diarrhea should suggest the diagnosis in most instances, resulting in prompt treatment of this usually life-threatening entity.

Isolated dislocation of the pisiform

From the literature it would appear that an isolated dislocation of the pisiform is a very rare entity. It may wrell be that the diagnosis is made less frequently than its true occurrence. An isolated dislocation of the pisiform is described with an accompanying brief review of the literature, clinical features and options of management. A 57-year-old fireman fell on his outstretched left hand. He noted stiffness, swelling and pain with flexion of the wrist but was not bothered sufficiently to seek immediate medical attention. He continued to work normally but experienced mild discomfort on lifting. Ten days following the injury he went to the emergency department. Radiographs were taken and no abnormality was noted (Fig. 1a, 1b). He was treated without immobilization for a sprained wrist. Subsequent to evaluation of the radiographs, in the Radiology Department, the patient was contacted and returned three weeks following the injury for re-evaluation. Examination at that time revealed no swelling or limit...

Superior gluteal artery haemorrhage following pelvic fractures controlled by embolisation

Successful embolisation of active bleeding from the superior gluteal artery seen in two patients within the last 12 months is described. Both patients had extensive abdominal and pelvic injuries. One patient eventually died from renal failure and a perforated colon. The other patient is mobile and has been periodically seen in the out-patient department over the past nine months. In both instances, haemorrhage was at the sacrosciatic notch. Early angiography, in patients with extensive pelvic trauma and major blood requirements, with intent to embolise any identifiable bleeding source would appear to be the best initial manoeuvre to prevent exsanguination.

Primary renal candidiasis: importance of imaging and clinical history in diagnosis and management.

Objective. Primary renal candidiasis is rare but increasing in incidence. The purpose of this series is to provide imaging and clinical findings for diagnosing candidiasis and to discuss imaging in the management of this disease. Methods. Ten sonographic, 8 retrograde pyelographic, 2 intravenous pyelographic, 2 antegrade pyelographic, and 2 computed tomographic examinations of 5 patients (4 adult male patients and 1 16‐year‐old female patient) were reviewed. Results. The clinical presentation was variable. Sonography showed renal pelvic wall thickening (n = 5), echogenic debris (n = 4), and fungus balls (n = 2). Papillary necrosis (n = 4), filling defects due to debris (n = 3), and fungus balls (n = 2) were seen on retrograde pyelography. Conclusions. Untreated candidiasis may progress to fungus ball or abscess formation. Sonography is commonly used as the initial imaging procedure. Retrograde and antegrade pyelography are used for biopsy, diagnosis, and treatment. Awareness of this condition and knowledgeable imaging evaluation can help detect and define the site, infection severity, and subsequent therapy.

Innocuous gas collections in pancreatic allografts demonstrated by computed tomography

Over a 4-year period, 6 pancreatic abscesses were found in 37 patients who had combined renal and segmental pancreatic transplants. An additional 4 patients who were nontoxic at the time of their computed tomographic (CT) examinations had innocuous gas collections, either in the pancreatic allograft or the surrounding peripancreatic tissue. The possible etiology of this gas formation is discussed. These collections do not have the same ominous clinical significance as would be expected in abscess formation. Radiological evaluation should include examination of the gastrointestinal tract and voiding cystograms to detect fistula formation. Simultaneous percutaneous aspiration of this area should be performed to rule out an infective process. If this is negative in a nontoxic transplant patient, the radiologist will be in a position to obviate unnecessary surgical intervention.

Delayed Traumatic Pseudoaneurysm of a Jejunal Artery A Case Report

The authors report a rare case of giant delayed traumatic pseudoaneurysm of a jejunal branch of the superior mesenteric artery secondary to abdominal trauma. A forty-seven- year-old patient presented with a painless, enlarging epigastric mass eleven years after a stab wound to the abdomen. A giant post-traumatic pseudoaneurysm of a jejunal artery was diagnosed by computed tomography, confirmed by ultrasound and angiography, and successfully treated surgically. This case demonstrates the importance of computed tomography in diagnosis of abdominal pseudoaneurysm in patients with previous abdominal trauma.

Role of Imaging in the Diagnosis of Chronic Pancreatitis and Differentiation from Carcinoma of Pancreas

Chronic pancreatitis is a disease of continuing inflammation that persists even after cessation of the initial etiologic agent. This condition can be clinically silent or associated with significant morbidity because of intractable pain, steatorrhea, loss of exocrine and endocrine function, and other complications. Chronic pancreatitis is primarily treated medically. Radiological, surgical, and endoscopic intervention is required for those patients with intractable pain and complications associated with the disease. Imaging (CT, sonography, endoscopic retrograde cholangiopancreatography, angiography) plays a significant role in diagnosis, in evaluating the anatomic and pathologic extent of disease and its complications, in excluding extrapancreatic causes of clinical manifestations, and in selecting among treatment alternatives.

CT Diagnosis of venous pseudotumors in the chest and abdomen

Appearances simulating neoplastic masses were found in five patients undergoing computed tomographic (CT) scanning of the chest and abdomen for a variety of indications. In each case the appearance was shown to be due to dilated collateral venous channels in association with portal hypertension or interruption of the inferior vena cava. The vascular origin of the masses was confirmed by CT scanning during intravenous bolus injection of contrast. Angiographic confirmation was obtained in three subjects.Enlarged collateral veins should be considered in the differential diagnosis of appearances suggesting mediastinal or abdominal lymphadenopathy at CT scanning.

Late renal transplant vein thrombosis associated with lymphocele - A case history

The authors present a case of delayed allograft renal vein thrombosis associated with compression from a perirenal transplant lymphocele. Realtime and Doppler ultrasound diagnosed thrombus within an enlarged renal transplant vein, high vascular impedance with absent venous signals, and a peritransplant lymphocele. The graft function was restored following percutaneous drainage of the lymphocele and anticoagulation therapy