Elizabeth S. Alexander

Digital Subtraction Angiography of the Renal Arteries: Prospective Comparison with Conventional Arteriography

Intravenous digital subtraction angiography (IV-DSA) of the aorta and renal arteries was compared with conventional arteriography of 40 patients with 92 renal arteries. Inadequate visualization of the vessel occurred in six renal arteries (6.5%). In arteries adequately imaged, for the evaluation of renal artery stenosis, the sensitivity of IV-DSA was 87.5% (28/32), the specificity 100% (54/54), and the accuracy 95.3% (82/86). Overall, accurate IV-DSA was obtained in 89.1% (82/92) of renal arteries and 85% (34/40) of the patients. IV-DSA is an accurate screening procedure for renal artery stenosis.

Computed tomography of gastrointestinal leiomyosarcoma

Computed tomography (CT) was performed in 6 patients with gastrointestinal leiomyosarcoma. The characteristic CT findings were a large extraluminal mass, apparently mesenteric in location, with central areas of necrosis. These findings were present in 5 of the 6 patients. Enhancement of the rim of the tumor was seen in 2 of 3 patients who had scans before and after administration of intravenous contrast material. CT identified the site of origin of tumor in only 2 patients. The characteristic CT findings should suggest the diagnosis of gastrointestinal leiomyosarcoma.

Fistulas and sinus tracts: radiographic evaluation, management, and outcome.

A retrospective review of 50 sinus tracts and 87 fistulas is presented. The etiologies, methods of radiographic evaluation including computed tomography and ultrasound, means of radiographic intervention, and disposition of sinus tracts and fistulas are discussed. Despite the newer imaging modalities, a sinogram or a fistulogram is still the best means of evaluating a sinus tract or fistula when an external communication is present. Computed tomography is helpful if exact spatial delineation of the tract is necessary or an associated abscess is suspected. Ultrasound examination is generally not useful, being limited by bowel gas and surgical incisions.

Computed tomography of retroperitoneal fluid collections

F LUID collections in the retroperitoneum generally consist of pus, hemorrhage, or urine. Infections in this area are typically subacute with nonspecific symptoms of chills, fever, night sweats, and pain. The retroperitoneum has been difficult to evaluate clinically; the diagnosis of retroperitoneal abscess or inflammation has been overlooked in 25-50s of patients.‘,’ Unfortunately, the morbidity and mortality increase with delayed diagnosis; failure to drain an abscess results in a mortality that approaches I OO%.’ For similar reasons, retroperitoneal hemorrhage and urinoma have been difficult to diagnose. With the advent of CT, however, the retroperitoneum can now be well demonstrated in most people. The normal bilateral symmetry, the usual abundance of fat, and the lack of motion in this region are ideal for CT examination.

CT of congenital anomalies of the inferior vena cava

The authors report six congenital abnormalities of the inferior vena cava detected on computed tomography (CT). The CT findings of one of these, the left inferior vena cava, have not been previously reported. The embryology of the inferior vena cava and the possible congenital abnormalities that can occur are discussed. Congenital abnormalities of the inferior vena cava are rare but potentially important to the radiologist, the surgeon, and the patient. They are easily identified on CT and should be considered when interpreting any CT of the abdomen or chest.