Charles J. Fagan

Traumatic lung and paramediastinal pneumatoceles.

Traumatic pulmonary and paramediastinal pneumatoceles are definite, acutely formed, primary structural manifestations incident to nonpenetrating chest trauma. They are not secondary lesions, i.e., cavities or pneumatoceles resulting from the resolution of a pulmonary hematoma. Awareness of this fact will explain the not uncommon finding of a cavitary lesion, often containing an air-fluid level, on initial emergency room radiographs of patients who have sustained closed chest trauma. This will avoid unnecessary and unpleasant diagnostic procedures, including thoracotomy, for traumatic pneumatoceles are self-limiting, benign abnormalities which usually require no therapy other than observation.

Pseudocoarctation of the aorta.

A case of pseudocoarctation of the thoracic aorta manifested by a mediastinal mass on a roentgenogram of the chest and subsequently evaluated with computed tomography (CT) is presented. The following combination of CT findings is thought to be diagnostic of this rare congenital anomaly: (a) demonstration that the mass is part of the aorta, (b) the depiction of the unusual aortic arch high in the mediastinum, (c) visualization of the isthmus portion of the descending aorta not adjacent to the spine but rather located ventral to it and surrounding by aerated lung, and (d) more caudal origin of the subclavian artery resulting in a vascular shadow posterior to the kinked aortic arch.

Abnormalities of the pharynx and larynx in childhood

A VARIETY of clinical presentations may lead one to suspect an abnormality of the pharynx or larynx in a child. In some children, respiratory distress or apneic spells may be the presenting problem, while in others it is stridor, hoarseness, or even dysphagia.4”6,29~35~44152~61, 93~96 Points in the clinical presentation may aid in differentiating some of these abnormalities, but more often definitive diagnosis becomes apparent only after adequate roentgen examination. In this regard, it is the lateral view of the neck, obtained in deep inspiration and with the neck fully extended, that is most helpful. Anything short of this often results in uninterpretable films or erroneous conclusions.

Traumatic Diaphragmatic Hernia into the Pericardium: Verification of Diagnosis by Computed Tomography

Computed tomography (CT) is a useful modality in the evaluation of mediastinal abnormalities and in the assessment of mediastinal masses for fat content. A case of posttraumatic herniation of the omentum and large bowel into the pericardial sac is presented. The mediastinal configuration, depicted on a CT scan, is thought to be diagnostic of this extremely rare abnormality.

Adult Wilms’ tumor: Clinical and radiographic features

The clinical and radiographic features of Wilms’ tumor in 4 adult patients are described. Wilms’ tumors in adults are usually bulky and contain numerous areas of necrosis and hemorrhage, imparting a complex appearance to the lesion on sonography and computed tomography. Angiography reveals the tumor to be hypovascular with some neovascularity. No specific features of the lesion differentiate it from hypernephroma. In contrast to the childhood variety, Wilms’ tumors in adults have ill-defined margins and frequently extend into the retroperitoneum. Their treatment is the subject of debate and prognosis is poor.

Sonographic features of carcinoma of the gallbladder

The sonographic features of carcinoma of the gallbladder are reviewed. Four cases of carcinoma of the gallbladder are presented which illustrate some, but not all, of the sonographic findings resulting from this abnormality. The findings illustrated are (a) a small gallbladder containing stones associated with a mass in the porta hepatis, (b) diffuse gallbladder thickening, fixation, and irregularity, (c) a papillary mass with an irregular border projecting from the gallbladder wall, and (d) a small, localized area of gallbladder wall thickening associated with cholelithiasis. Although inflammatory disease of the gallbladder can present similar sonographic findings, the correlation of the clinical findings and close inspection of the sonographic changes illustrated and described in this publication may allow the only means of a preoperative diagnosis of carcinoma of the gallbladder.

MR imaging of mediastinal pseudocyst.

Magnetic resonance imaging of a mediastinal pseudocyst clearly demonstrated the entirely intrathoracic location of the pseudocyst.

Chronic ectopic pregnancy

A chronic ectopic pregnancy is a form of tubal pregnancy in which there is gradual disintegration of the tubal wall with slow and/or repeated episodes of hemorrhaging leading to the formation of a pelvic mass. A review of 22 pathologically proven cases of this entity revealed the pelvic mass to be a hematocele, or a sealed‐off inflammatory mass composed of blood clots, organized hematomas, and surrounding adhesions. Sonographically, the abnormality is manifested by an extrauterine, complex mass in the adnexa(e) and cul‐de‐sac. The mass may obliterate uterine margins and be confused for pelvic inflammatory disease, endometriosis, or uterine leiomyomas. With an increased awareness of this entity and its mildly symptomatic and protracted clinical course, a preoperative diagnosis should be possible.

Sonographic demonstration of bladder-flap hematoma

A bladder‐flap hematoma is generally thought of as a blood collection in a potential space located between the urinary bladder and lower uterine segment (vesicouterine space). These collections can also extend over the bladder and uterus beneath the peritoneal reflection. In this study, ten patients with a bladder‐flap hematoma were evaluated for fever, mass, or dropping hematocrit after surgery. No one sonographic appearance is specific for bladder‐flap hematoma; however, the diagnosis can be made by finding a mass in the extraperitoneal pelvic space in the postoperative patient.

Benign Urachal Cyst in an Adult

Benign urachal cyst is a rare lesion in the adult. Prompt diagnosis and management are important to avoid complications. This report illustrates the value of computed tomography (CT) in establishing the diagnosis of urachal cyst in a case in which conventional radiography and ultrasonography were normal. In any patient with a history or physical findings suggestive of a urachal anomaly, CT is most useful in establishing the nature of the anomaly and extent of the lesion. In this case, CT findings of a soft tissue mass at the bladder apex continuing superiorly as a tubular structure were consistent with infected urachal cyst.