Errol Levine

Renal cell carcinoma in uremic acquired renal cystic disease: Incidence, detection, and management

Patients with end-stage kidney disease, particularly those treated with dialysis, have an increased risk of renal cell carcinoma. Renal cell carcinoma may also develop in the native kidneys of renal transplant recipients with good graft function many years after transplantation. Recent studies suggest that the incidence of renal carcinoma among dialysis patients is 3-6 times greater than in the general population. However, annual imaging of the native kidneys of all dialysis patients is not justified because it has not been shown to have a significant effect on patient outcome. Screening may, however, be useful in selected patients with good general medical conditions and who have known risk factors for renal carcinoma.

Comparison of computed tomography and ultrasound in abdominal staging of renal cancer

The relative accuracy of computed tomography (CT) and ultrasound in abdominal staging of renal cancer was determined in 22 patients. CT is capable of detecting tumor invasion of perinephric fat and adjacent muscles, which cannot usually be shown by ultrasound. While both CT and ultrasound demonstrate venous and retroperitoneal tumor extension, CT is more reliable since bowel gas not infrequently obscures the retroperitoneum on ultrasonic scanning. However, ultrasound will often provide valuable information; and whenever a solid renal mass is detected by echography using prone scans, abdominal scans should be obtained for staging pruposes.

Three-Dimensional Reconstruction From Serial Sections For Medical Applications

Three-dimensional display algorithms using computer graphics are evaluated for potential clinical utilization. The authors are utilizing triangular tiles for organ surface reconstruction based on contour information generated from computed tomography (CT), ultrasound examinations, and nuclear medicine examinations. Comparisons have been established among several triangular tiling algorithms which include the number of points required to adequately specify the contours, computer execution time, and the errors in reconstruction. The triangular tiling algorithm provides a means for accurately estimating the volume and surface area of the desired anatomic sites. Examples of studies include brain lesions, computed tomography radiation treatment plans, spleen, and nuclear medicine slant hole camera studies.

CT Evaluation of Active Adrenal Histoplasmosis

We describe three patients with puzzling systemic illnesses in whom computed tomography (CT) led to the diagnosis of active adrenal histoplasmosis. CT was performed in two patients because of gastrointestinal symptoms and weight loss and in the third because of fever developing 2 years after an apparent cure of histoplasmosis. All three patients had adrenal enlargement on CT with features of granulomatous adrenal disease in two. Hormone assays performed after CT supported the diagnosis of adrenal insufficiency and fine-needle adrenal aspiration biopsy with special stains of the aspirates showed histoplasma organisms in all three patients. The combination of adrenal enlargement on CT and laboratory findings of adrenal insufficiency should suggest the diagnosis of histoplasmosis, especially in endemic areas.

Perinephric Hemorrhage in Autosomal Dominant Polycystic Kidney Disease: Ct and Mr Findings

Perinephric hemorrhage is a rare complication of autosomal dominant polycystic kidney disease (ADPKD). Of 66 patients in our series, it occurred in two (3%) and their clinical and radiologic findings are described. Computed tomography accurately delineated both hematomas and revealed an underlying ruptured hemorrhagic renal cyst in one patient. Computed tomography did not show the cause of hemorrhage in the other patient, but magnetic resonance (MR) imaging detected an underlying hemorrhagic cyst. Perinephric hemorrhage in ADPKD probably results from rupture of hemorrhagic renal cysts into the perinephric space. Computed tomography is the optimal method for its evaluation. However, MR may supplement CT findings since it detects more hemorrhagic cysts than CT and helps distinguish them from carcinomas. Perinephric hemorrhage in ADPKD can usually be managed conservatively.

Detection of a wooden foreign body in the hand using computed tomography-Case report

Computed tomography (CT) detected and precisely localized a nonmetallic foreign body of the hand after fine-detail radiography had failed to delineate the foreign body. Surgical exploration was aided by this noninvasive preoperative evaluation. In carefully selected cases of suspected nonmetallic foreign bodies in the extremity, CT can be a valuable diagnostic tool.

Abdominal visceral calcification in secondary amyloidosis: CT findings

Amyloid fibrils have an affinity for calcium, and radiographically detectable calcified amyloid deposits may occur in both primary and secondary amyloidosis. However, abdominal visceral calcification is rare. A patient with secondary amyloidosis due to juvenile rheumatoid arthritis is described who developed extensive liver, adrenal, and renal calcification shown by computed tomography. Adrenal calcification in amyloidosis has not been previously described.

Cost Of Managing Digital Diagnostic Images For A 614 Bed Hospital

The cost of recording and archiving digital diagnostic imaging data is presented for a Radiology Department serving a 614 bed University Hospital with a large outpatient population. Digital diagnostic imaging modalities include computed tomography, nuclear medicine, ultrasound, and digital radiography. The archiving media include multiformat video film recordings, magnetic tapes, and disc storage. The estimated cost per patient for the archiving of digital diagnostic imaging data is presented.

Carcinoma of the pancreas presenting as acute pancreatitis: CT diagnosis.

Three cases are reported in which acute pancreatitis was the presenting manifestation of an underlying carcinoma of the head of the pancreas. The rare association of acute pancreatitis and pancreatic carcinoma is reviewed and possible pathogenetic mechanisms are discussed. An underlying neoplasm should be suspected in a middle-aged or elderly patient presenting for the first time with acute pancreatitis for which no other cause is found. CT may suggest the correct diagnosis by identifying focal rather than diffuse pancreatic involvement, pancreatic duct dilatation, or lymphadenopathy.Three cases are reported in which acute pancreatitis was the presenting manifestation of an underlying carcinoma of the head of the pancreas. The rare association of acute pancreatitis and pancreatic carcinoma is reviewed and possible pathogenetic mechanisms are discussed. An underlying neoplasm should be suspected in a middle-aged or elderly patient presenting for the first time with acute pancreatitis for which no other cause is found. CT may suggest the correct diagnosis by identifying focal rather than diffuse pancreatic involvement, pancreatic duct dilatation, or lymphadenopathy.

Computed tomographic and ultrasonic appearances of primary carcinoma of the common bile duct.

Two patients with obstructive jaundice due to surgically proved primary carcinoma of the common bile duct were examined by CT and ultrasound. The combination of the two modalities showed dilatation of the extrahepatic biliary system and the main pancreatic duct. The diagnosis of primary bile duct carcinoma is suggested by these findings in the presence of a normal pancreatic head, although similar findings may occur with a small pancreatic or ampullary carcinoma.