Frederick M. Kelvin

CT detection of typhlitis.

A case of typhlitis (neutropenic colitis) is reported in which the initial diagnosis was suggested by CT. Radiologists performing CT should be aware of this potentially lethal complication of leukemia, which may appear as a clinically unsuspected finding on CT.

Fluoroscopic Placement of Nasojejunal Feeding Tubes with Immediate Feeding Using a Nonelemental Diet

A method for fluoroscopic placement of an Erythrothane (8 French) feeding nasojejunostomy tube with a wire stylet is described. Two hundred thirty-eight feeding tubes were passed successfully to or beyond the Ligament of Treitz in 141 patients with an average fluoroscopy time of 5.3 min/patient. A nonelemental diet was administered without difficulty through the tubes by continuous infusion immediately after placement. This technique was found useful in avoiding total parenteral nutrition in patients with poor gastric emptying in situations such as the immediate postoperative period, drug-induced nausea, and in the presence of an altered mental status.

The spectrum of small bowel melanoma.

Twenty-one patients with documented secondary small bowel involvement by malignant melanoma are reviewed. Roentgen mainfestations are discussed and illustrated. A vigorous diagnostic approach emphasizing enteroclysis is described. Clinical awareness and aggressive radiologic investigation are providing these patients with earlier surgical and adjuvant therapy, which appears to be leading to increased length of survival.

Computed tomography of pneumatosis intestinalis

Four cases of pneumatosis intestinalis detected by computed to mography (CT) are described. Plain abdominal films obtained on the same day as CT failed to show pneumatosis in three of the four cases. The CT appearances characteristic of pneumatosis intestinalis are cystic, linear, or curvilinear gas collections in the periphery of distended, partly fluid-filled loops of bowel. Two of the four cases had underlying bowel infarction. Evidence of pneumatosis should be carefully looked for in patients with acute abdominal pain referred for CT examination. Computed tomography may be a useful modality for the early diagnosis of bowel ischemia when plain abdominal films are non-contributory.

CT appearance of diffuse mesenteric edema.

The extent of pathologic processes involving the mesentery is frequently difficult to assess by clinical examination and standard radiography. Contrast studies of the gastrointestinal tract only identify the effect of these processes on adjacent opacified bowel loops and frequently underestimate the extent of mesenteric pathology. Computed tomography has previously been used to characterize various mesenteric abnormalities, most often secondary to malignant or inflammatory disease. We report the characteristic CT appearance of diffuse mesenteric edema in 14 patients. Eleven patients had documented hypoalbuminemia, two patients superior mesenteric vein thrombosis, and one patient cirrhosis. The CT findings that allowed confident diagnosis of this entity include increase in density of the mesenteric fat, poor definition of segmental mesenteric vessels, relative sparing of the retroperitoneal fat, and association with subcutaneous edema.

A reversible enteropathy complicating continuous hepatic artery infusion chemotherapy with 5‐fluoro‐2‐deoxyuridine

This article describes two patients with hepatic metastases from colorectal cancer in whom a reversible enteropathy developed during the administration of hepatic artery infusion chemotherapy with 5‐fluoro‐2‐deoxyuridine (5‐FUdR) via an Infusaid Series 400 pump (Infusaid Corp., Sharon, MA). Both patients had severe diarrhea and signs that suggested small bowel obstruction. Barium studies revealed a distinctive radiologic appearance of severe narrowing of the ileum associated with complete loss of normal mucosal patterns. Results of an extensive evaluation for an infectious or toxin‐related enterocolitis were negative. Perfusion studies confirmed the appropriate position of the catheters and revealed no extrahepatic perfusion. Systemic shunting of the 5‐FUdR through the liver or tumor bed is postulated as the primary event, with the small bowel manifesting the major toxicity.

Computed tomography of the ileocecal region.

The CT scans in 25 patients without ileocecal pathology and 52 patients with ileocecal abnormalities were retrospectively reviewed. The ileocecal region was identified in 18/25 (72%) of patients without pathology. Thirty of 52 patients with ileocecal pathology had inflammatory disease: Crohns (13), appendicitis (9), abscess (6), and typhlitis (2). CT was complementary to barium studies, demonstrating wall thickening, pericolonic inflammatory change, masses, fascial thickening, and fistulae. Twenty patients had malignancy: primary carcinoma (9), metastases (7), and lymphoma (4). In all patients with carcinoma a mass was identified. Pericolonic stranding represented tumor extension in 5/6 patients. Metastases were identified as extrinsic ileocecal masses in all 7 patients. Liver, mesenteric and omental metastases were present in 8/20 patients. In patients with lymphoma there was wall thickening and two had additional pericecal lymphadenopathy. In 2 patients with hypoalbuminemia, findings included: wall thickening, mesenteric, and subcutaneous edema.

Duodenocolic fistula due to adenocarcinoma of the pancreas

A case of duodenocolic fistula due to pancreatic adenocarcinoma is presented. The causes and clinical and radiographic features of duodenocolic fistulae are discussed.

Abstracts Papers presented at the Eleventh Annual Session of the Society of Gastrointestinal Radiologists, October 1, 1981, Boca Raton, Florida

Papers Presented at the Eleventh Annual Session of the Society of Gastrointestinal Radiologists, October 1, 1981, Boca Raton, Florida ESOPHAGEAL NODULARITY A NORMAL VARIANT OF THE ESOPHAGEAL MUCOSA Seth N. Glick, M.D. Steven K. Teplick, M.D. Department of Diagnostic Radiology Hahnemann Medical College and Hospital 230 North Broad Street Philadelphia, PA. 19102 Small superficial round nodules (2-4 mm) are frequently observed on routine double contrast esophagrams. They may be focal or diffuse, and appear as fine granularity or sharply defined filling defects. Endoscopic~lly, they are seen as white excrescences on a normal mucosal background. However, they may not be appreciated, unless specifically sought, becaUse of inadequate lumenal distension. Biopsy reveals normal or slightly hyperplastic squamous epithelium and vacuolated epithelial cells containing abundant glycogen. This has been termed glycogenic acanthosis. Esophageal symptoms are usually absent or cannot be correlated with this morphology. We evaluated 300 consecutive esophagrams considered to demonstrate adequate mucosal detail. Nodularity was found in 30%. These were usually confirmed endoscopically when sought. In addition to true nodules, pseudo-nodules may be caused by several types of artifacts such as transverse esophageal folds. Several pathologicconditions may resemble the normal esophageal nodules, however, radiologic and clinical criteria can usually make the distinction. The Esophageal Survey in Upper Gastrointestinal Radiography Dean D. T. Maglinte, M.D., Katharine L. Krol, M.D., Lloyd D. Caudill, M.D., David L. Brown, M.D., and William Michael McCune, M.D. Gastrointestinal Radiology Section Methodist Hospital and Graduate Medical Center, 1604 North Capitol Ave., Indianapolis, IN 46206 When an upper gastrointestinal study is requested on a patient with non-specific abdominal complaints, there are no guidelines as to what should be the minimum esophageal survey. Of 200 patients referred for upper gastrointestinal series, 40 (20%) had radiographic evidence of esophageal disease. Reflux esophagitis, frequently considered difficult to diagnose radiographically, was demonstrated in 31 (16%). A non-invasive carcinoma, varices and a leiomyoma were found. It is suggested that a thorough evaluation of the esophagus consisting of double contrast, single contrast distention radiograph, fluoroscopic motility assessment and mucosal relief study be included in every upper gastrointestinal series. This minimum multiphasic routine evaluation offers the potential for improvement in diagnostic accuracy with little additional examination time. Barium Swallow After Total Laryngectomy Koehler RE, Balfe DM, Setzen M, Weyman P J, Baron RL, Ogura J Department of Radiology and Divls]on of Otolaryngology, Washington University School of Medicine, St. Louis, Mo Dysphagia is a frequent problem in patients who have undergone total laryngectomy and the barium swallow is often useful for evaluaHng the cause for the symptoms. The examination may be di f f icul t to interpret, however, because a variety of anatomic changes may be produced by radiation, infection, fistula, recurrent tumor or the operation itself. We analyzed radiographs and clinical information on 43 patients with total laryngectomy with followup periods ranging from g months to 17 years. Recurrent tumor was found in IS patients and was evident radiographically as a mass deviating the neopharynx in 14. Benign strictures in nine patients apeared either as a long symmetrical r~arrowing or as a very short, weblike narrowing. Fistulas were demonstrated in 12 patients and presaged the development of recurrent tumor in five. Cricopharyngeal muscular-dysfunctlon accounted for the dysphagia in five cases. An understanding of these patterns leads to more accurate interpretation of the postoperative barium swallow and the radiographic findings often indicate the correct diagnosis with a high degree of confidence. 0364-2356/82/0007-0087

Extraperitoneal Gas Following Nephrectomy: Patterns and Duration

01.80 9 1982 Springer-Verlag New York Inc.