Charles C. Lu

Midgut volvulus as a complication of intestinal malrotation in adults

Seven adults with midgut volvulus as a complication of malrotation are presented. All patients were men with an average age of 33 years. Four presented with long histories of intermittent abdominal pain. In three patients, the twisted, corkscrew appearance of the barium column in the duodenum and proximal jejunum in an upper gastrointestinal series made the diagnosis. In the remaining patient, small-bowel follow-through performed three years before surgery showed intestinal malrotation. Three patients presented with the acute onset of severe abdominal pain. Plain films showed small-bowel obstruction and pneumatosis intestinalis in two patients and only nearly complete small-bowel obstruction in the third. Barium studies were not done in this group because of the need to proceed to exploratory laparotomy and the risk of perforation. In one patient, abdominal angiography suggested the diagnosis by showing abnormal courses of the mesenteric vessels to the volvulized segment of small bowel. All three of these patients showed ischemic segments of bowel at laparotomy.

CT findings of plexiform neurofibromatosis involving the ileum and its mesentery

We present a case of plexiform neurofibromatosis involving the ileum and its mesentery. Computed tomography (CT) scans showed a cluster of small soft-tissue density nodules, which represented a cross-sectional image of the enlarged peripheral nerves and wall thickening of the distal ileum. Trapped fat tissue was demonstrated between these enlarged nerves. Histopathologic studies of the resected specimen correlated well with CT findings.

Dynamic evaluation of swallowing in patients with cerebrovascular accident

To determine the specific effects of cerebrovascular accident (CVA) on deglutition, especially relative to the site of CVA, we studied videotapes of barium swallow examinations in 74 patients who had had a CVA. Although there was no distinct correlation between the prevalence of oral and pharyngeal dysfunction and the site of CVA, left CVA was prone to impair only the oral phase, and right CVA tended to impair both phases.

CT of abdominal abscess with fistulous communication to the gastrointestinal tract.

We review CT of 24 cases of intraabdominal abscess with fistulous communication to the GI tract confirmed by GI contrast study or fistulogram. Underlying causes of fistulization included recent GI tract surgery (13), diverticulitis (four), unknown etiology (three), malignant neoplasm (two), trauma (one), and pancreatitis (one). Thirteen (54%) abscesses showed air-fluid levels, 14 (58%) showed air bubbles, and seven (29%) showed both. Bowel contrast material was administered in 21 cases, and optimal bowel opacification was effected in 16. However, contrast extravasation into the abscess was noted in only six cases. We conclude that an air-fluid level may indicate the presence of a fistulous communication to the GI tract, but its absence does not necessarily mean there is no communication. Also, recognition of contrast within the abscess is uncommon even with optimal bowel opacification. In cases of clinical suspicion of internal fistula, a fistulogram or GI contrast study should be performed.

Dynamic imaging of obstructed opossum esophagus : from altered load to altered contractility

We studied by barium contrast the dynamics of experimental obstruction in the opossum esophagus. Immediately after banding the gastroesophageal junction, entrapment of the bolus between the band and the peristaltic contraction led to esophageal bulging, forceful retropulsion of the bolus at the band, and the repeated triggering of peristaltic contractions by the retropelled bolus. In ensuing weeks, triggering of contractions became more difficult and contractions led to bizarre “corkscrew” movements of the increasingly distended and tortuous esophagus. A tight contraction ring that moved very slowly retrograde was occasionally observed in the chronically distended esophagus. Computer-assisted analysis showed that the area and perimeter of the bolus were abnormally large in chronic obstruction and that during its passage through the esophagus the compactness of the bolus increased no longer. Configurational analysis of the cone that the peristaltic contraction shapes at the tail of the barium column showed this to narrow progressively on passage through the normal esophagus and, paradoxically, to widen in both acute and chronic obstruction.

Renal sinus malignant lymphoma: A case report

We report a case of renal sinus non-Hodgkins lymphoma without contiguous adenopathy. Magnetic resonance and computed tomography images of this rare tumor were correlated with a pathologic specimen. On computed tomography the renal sinus lymphoma was evaluated as a well circumscribed, low-density mass owing to the mixture of the lymphomatous cells and fat tissues. Magnetic resonance showed the replacement of the renal sinus fat tissues with a spoke-like solid mass. The renal artery and vein were also evaluated thoroughly and were without tumor thrombosis.

Magnetic resonance imaging of renal vein and inferior vena cava thrombosis in a patient with glomerulonephritis: A case report

We report a case of bilateral renal vein and inferior vena cava thrombosis in a patient with membranous glomerulonephritis. To the best of our knowledge, this is the first case demonstrated by magnetic resonance imaging.

Base line tenting: A sign of duodenal ulcer disease

Indirect signs such as clover-leaf deformity, pseudodiverticulum formation, eccentric location of pyloric channel, and flattening of the fornix are of considerable value in the radiologic detection of an ulcer crater. We have found another indirect sign, base line tenting (BLT) to be very useful in the detection and diagnosis of duodenal ulcer disease. This is characterized by interruption of the base line of the bulb, with 2 associated perpendicular lines extending from the base and converging to a point in the duodenal bulb. After we observed this sign in various patients with peptic ulcer disease, a prospective investigation was performed involving 62 patients with duodenal ulcer disease over a period of 2 years. We found the BLT sign in 52 (83.8%). To date, no false-positive incidence has been identified. We concluded that BLT is a most valuable sign in the radiologic identification of duodenal ulcer disease.