David M. Witten

Application of computed tomography in differential diagnosis of radiographic opacities in the lower thorax and upper abdomen

The differential diagnosis of radiographic homogeneous opacities in the lower thorax and upper abdomen is very often a dilemma for radiologists. Recently we have encountered the following 8 cases in which the correct radiologic diagnoses (confirmed pathologically) were made only by computed tomography: pyogenic liver abscesses (2 cases), subphrenic hematoma, pancreatitis with pseudocyst, adrenal cortical carcinoma, ovarian carcinoma with liver metastasis, lower lobe pulmonary infarction, and metastatic breast cancer in the peri-esophageal region. The CT findings displayed not only the anatomic location and extent of these lesions but also the unique characteristics of many of the pathologic processes that produce these otherwise nonspecific radiographic opacities. It is our purpose here to demonstrate the CT findings in such patients and to advocate CT study as a very effective diagnostic modality in those patients who present with radiographic homogeneous opacities in the lower thorax and upper abdomen.

Unusual involvement of the rectum by carcinoma of the prostate

The authors present three cases in which carcinoma of the prostate simulates a primary carcinoma of the rectum. Direct invasion by prostatic carcinoma should be included in the differential diagnosis of mass lesions of the rectum in males.

Iatrogenic Dilatation of the Upper Urinary Tract During Radiographic Evaluation of Patients with Spinal Cord Injury

Patients with upper and lower motor neuron spinal cord injuries were observed to determine whether cystography immediately before excretory urography induced iatrogenic dilatation of the upper urinary tract that was indistinguishable from true pathological dilatation. Evidence is given that such dilatation occurs. This iatrogenic dilatation is not seen in patients with normally innervated urinary tracts and appears to be caused by exaggerated bladder reflexes in patients with upper motor neuron lesions. Bladder spasms precipitated by cystographic contrast material also may create vesicoureteral obstruction and lead to dilatation of the upper urinary tract. Consequently, it is suggested that cystography should not immediately precede excretory urography. When such a sequence is necessary, room or body temperature contrast medium should be used for the cystogram, the bladder should be emptied before the excretory urogram is started and a 1-hour interval should be allowed between the 2 procedures. The findings also suggest that any factors that induce repeated or continuing bladder spasms may contribute to progressive dilatation of the upper urinary tract.

Film/Screen Considerations in Tomography

The physical factors underlying perception of detail in thin-section tomography are discussed. A thin-section tomogram using a film/screen combination which takes advantage of these factors is compared with one which does not. Even though such a combination is not as sharp, more detail is displayed with no increase in patient exposure.

Intraoperative Roentgenography in the Surgical Removal of Renal Calculi

Complete surgical removal of staghorn or multiple renal calculi is extremely difficult. Intraoperative roentgenography has been used to decrease the incidence of residual calculi. We herein assess the effectiveness of intraoperative roentgenography and emphasize important operative technical aspects. Between 1973 and 1979, 42 patients underwent 50 operations for the removal of staghorn or multiple renal calculi. Intraoperative roentgenography was used in 47 operations and omitted in 3. Of the 47 operations done with intraoperative roentgenography 31 units were free of stones and 12 had small retained fragments known intraoperatively with verification by postoperative tomography or plain abdominal film. In 1 case of calculus recognized intraoperatively passed during the postoperative period and tomograms demonstrated no residual calculi. Only 3 patients had residual stones postoperatively with negative intraoperative films. The 3 patients who did not have intraoperative roentgenography all had residual fragments. All 3 kidneys were thought to be free of residual stones as determined by visual inspection and nephroscopy. With the aid of intraoperative roentgenography the incidence of residual stones was 23 per cent. Followup for up to 6 years in 45 renal units showed 73 per cent to be free of stones. When properly used intraoperative roentgenography is highly accurate. Films should be obtained before any stones are removed and care should be taken to x-ray the entire kidney even if 2 films are required. Final films should be obtained after all fragments are removed.

Benign Gastric Ulcer with “Crescent” (Quarter Moon) Sign

Three cases of benign gastric ulcer with Nelsons “crescent sign” are described. The characteristic fluoroscopic and radiographic findings arc: (a) a large filling defect along the greater curvature of the antrum during fluoroscopy, (b) delayed filling of the crater with barium, and (c) crescent-shaped collection of barium in in the crater.

Clinical Trial of Bilopaque (Tyropanoate Sodium) Oral Cholecystography Evaluation of Time for the Optimal and Peak Opacification of the Gallbladder

Cholecystography was performed in 89 consecutive patients at four-, six-, eight-, ten-, and twelve-hour intervals after ingestion of Bilopaque (tyropanoate sodium). In 78 the optimal and peak times of gallbladder opacification were evaluated. In all 78 the gallbladder was opacified on the eight-hour film. It was opacified on the four-hour film in 61 (78%), and the opacification on the four-hour film was sufficient for diagnosis in 50 (64%).

A Comprehensive Quality Assurance Program: A Report Of Four Years' Experience At The University Of Alabama In Birmingham

General considerations in organizing a quality assurance program are discussed. The development and general features of the program at UAB, which consist of a cooperative effort between the quality control technologist, the radiological service engineering staff and the radiation physicist, are briefly reviewed. The economic efficacy of such a program is justified by comparing data on film consumption before and after the program was established and by comparing estimates of x-ray vendor contracted service cost with that of inhouse service.