Francis F. Ruzicka

The Portal Venous System: On Its Pathological Roentgen Anatomy

This report is prompted (as part of continuing studies on the problem of portal hypertension) by recognition of the need for basic information on the interpretation of portograms in the living subject. This need was satisfied in part by data obtained in a previous postmortem study of the roentgen anatomy of the normal portal venous system (Doehner et al., 1955) permitting the identification of normal vessels and evaluation of normal variations in their diameter. Other features, such as collateral channels, remained a problem. A similar investigation was therefore undertaken of the abnormal portal system. This series comprises a total of 40 cases, including 34 of cirrhosis of some type: 26 cases of Laennecs cirrhosis, 2 of Laennecs cirrhosis with liver metastasis, 1 of Laennecs cirrhosis with hemochromatosis, 1 of cirrhosis with schistosomiasis, 2 of biliary cirrhosis, 1 of biliary cirrhosis with metastasis, and 1 of congestive cirrhosis (on cardiac basis). Two cases of congested liver and 4 of metastat...

The Portal Venous System: Its Roentgen Anatomy

With the advent and development in recent years of successful surgical treatment of portal hypertension (1, 2, 3, 15) in the form of the veno-venous shunt, there has naturally arisen a demand for roentgen visualization of the portal system as an aid in intelligent treatment planning. Previously, surgeons who performed such shunting procedures were forced to embark upon them with little or no preoperative information on the particular anatomical configuration of the portal vessels. Much of the operative time, therefore, was consumed in locating the various trunks. The type of shunting operation was either decided preoperatively, without any knowledge of the particular anatomical relationships, or after extensive exploratory dissection of the upper abdomen, with or without differential venous pressure readings. Surgeons experienced in this field have not infrequently encountered an inoperable anatomical situation only after a long, arduous dissection. In an earlier publication (16), roentgen visualization o...

Arterial portography: patterns of venous flow.

Over the last fifteen years splenoportography has provided an understanding of flow patterns that may be seen with the various forms of portal venous obstruction (1, 2). Although the entire portal system is seldom visualized by this technic of injection of contrast medium into the spleen, many basic hemodynamic principles have been determined and correlation made with a variety of types of pathology that involve the portal system (3, 4). With the introduction of selective visceral arteriography (celiac and superior mesenteric) it has been possible to recognize certain of the same venous patterns that are seen with splenoportography (5–8). However, there are certain differences which can be readily appreciated and understood when the site of injection is kept in mind. Opacification of the venous side after injection into an artery has always been fraught with the problem of the dilution effect which occurs in the transcapillary passage of the contrast medium, especially when injection is made into an arter...

XEROMAMMOGRAPHY AND FILM MAMMOGRAPHY, A COMPARATIVE STUDY.

Physical Considerations The xerographic process is based upon the electrical characteristics of certain semiconductors such as selenium which, although normally good insulators, become charge conductors under the action of light or ionizing radiation. If a metal plate is coated with such a material, the resultant product can be used in numerous applications as a substitute for conventional photographic emulsion. A xerographic plate consists of a metal surface coated with a thin layer of selenium. An electric charge may be uniformly deposited upon the selenium layer. If the plate is then placed in a light-proof box into which is introduced a cloud of powder which has been given an electrical charge of polarity opposite to that of the plate, the powder will be attracted to the plate and uniformly deposited upon it. If a freshly charged plate is exposed to x-rays, the charge will leak off the selenium to the metal plate directly behind. The amount of charge which leaks off is related to the incident x-ray ex...

Anomalous and parasitic arterial blood supply in the abdomen.

Abstract Vascular radiology is useful in determining the location and extent of abdominal neoplasms. In evaluating these parameters, variants or anomalies of origin of certain vessels must be kept in mind in order to avoid incorrect localization of the lesion as well as a mistaken diagnosis of parasitic blood supply. True parasitic blood supply appears in two forms; the parasitic blood supply may be provided via anastomotic communications or by actual invasion of a contiguous structure or organ.

The intrahepatic vasculogram and hepatogram in cirrhosis following percutaneous splenic injection.

Although portal venography has been extensively used to study the extrahepatic portal venous system (1, 3, 4, 7, 8, 12, 13), only relatively minimal attention has been paid to evaluation of the diseased liver by means of the same procedure (1, 2, 7, 8). Rigler and Olfelt (10, 11) have employed aortography to visualize the portal venous system and by this transcapillary method to opacify the liver. Daniel et at. (5) in 1952 demonstrated the potentiality of direct portal venography for study of the cirrhotic liver in rats in which cirrhosis had been experimentally produced. We have found splenoportography a useful means for investigation of certain disease processes of the liver. The present paper constitutes a preliminary report of such a study. The technic routinely employed in this project is as follows: 40 c.c, of opaque medium (70 per cent Urokon) is injected into the spleen in approximately twelve seconds. Serial films are made at two, four, six, eight, and twelve seconds following the beginning of in...

Differentiation of Intrahepatic and Extrahepatic Masses by Arteriography1

The localization and etiologic identification of a right upper quadrant mass may present a difficult diagnostic problem. At times, a correlation of plain film findings such as the displacement of surrounding structures or the presence of abnormal calcifications may suggest the character of a specific lesion; but often the changes are nonspecific, so that it is impossible to establish the precise location or nature of the disease. The liver scan or a combination of liver-lung scan, pneumoperitoneum, and presacral air insufflation is used with varying degrees of success to determine whether a mass is intra- or extrahepatic. In our experience, however, celiac or hepatic arteriography has proved to be the definitive means of determining the location of the right upper quadrant mass and has provided important additional clues concerning its etiology. In differentiating intrahepatic and extrahepatic masses by angiography, the following points are considered: (a)The origin and identification of the feeding vesse...

Angiographic Localization of Pheochromocytoma

In the study of hypertension, renal vascular lesions were the only indication for angiography until recently, when clear radiographic demonstrations of pheochromocytoma were obtained following the injection of contrast medium into the aorta, or after selective renal artery catheterization (1, 3, 7, 8, 10, 12, 16, 19, 21, 22a). In the past, hypertensive patients in whom pheochromocytoma was suspected were examined by conventional radiographic technics only, mainly intravenous pyelography and retroperitoneal pneumography (20–24). Although pheochromocytomas may arise in the chromaffin tissue anywhere in the body (9, 17, 18), the overwhelming majority arise in the adrenal glands. Our main concern in arteriography for their diagnosis, then, is the visualization of the vessels leading to these glands. Usually three arteries supply the suprarenal gland (13): the superior, the middle, and the inferior suprarenal. The superior suprarenal artery arises from the inferior diaphragmatic artery, the middle directly fro...

Thyroid angiography—techniques, anatomy and indications

Abstract Selective thyroid angiography provides a safe and effective method of investigation for thyroid and parathyroid lesions. Selective injections into all four thyroid arteries are made via the femoral route, and subtraction is used routinely in all studies. Indications for the procedure include investigation of parathyroid tumours, thyroid masses, mediastinal masses to be differentiated from substernal thyroid, and vascular abnormalities of the thyroid. Characteristic findings in parathyroid adenoma, thyroid adenoma, thyroid carcinoma, metastatic disease to the thyroid and vascular anomalies of the thyroid are discussed.

The Hepatic Wedge Pressure and Venogram vs. the Intraparenchymal Liver Pressure and Venogram

Abstract Percutaneous hepatic intraparenchymal and hepatic wedge studies, including venography and pressure measurements, were compared. Both techniques provide almost identical radiographic information in most cases. Although a percutaneous transthoracic intraparenchymal study is simpler to perform, the hepatic wedge technique (via the femoral vein) is subject to fewer artifacts of pressure measurement and also allows evaluation of free hepatic vein and inferior vena caval pressures.