G. Leland Melson

Computed Tomography of the Adrenal Gland

Computed tomography (CT) easily and accurately demonstrates both the normal and abnormal adrenal gland. The normal adrenal gland can be seen in almost 95% of patients. With this technique, 29 of 29 proved adrenal masses were demonstrated; one case of bilateral adrenal hyperplasia could not be recognized, another showed equivocal enlargement. CT is an excellent screening and often definitive radiologic test of evaluating the adrenal gland.

High resolution sonography in diagnosing testicular neoplasms: clinical significance of false positive scans.

We describe the use of high resolution real-time ultrasound to evaluate scrotal masses. From August 1980 to September 1984, 249 patients underwent scrotal ultrasound using high resolution real-time scanners with 10 mHz. transducers to evaluate scrotal abnormalities. The ultrasound diagnosis was consistent with a testicular neoplasm in 20 patients. Pathological and surgical confirmation was available in all 20 patients. Only 10 of 20 patients had malignant tumors, whereas 10 had benign lesions (false positive rate of 50 per cent). Testicular lesions producing false positive studies were principally hypoechoic in 8 patients and hyperechoic in 2. Testicular neoplasms characteristically were hypoechoic with or without focal hyperechoic areas. There was 1 false negative ultrasound study. Our results suggest that radical orchiectomy should not be performed indiscriminately in all patients with testicular lesions that are sonographically suspicious for neoplasm. In selected cases with hyperechoic sonographic features associated frequently with benign testis lesions open testicular biopsy and a testis-sparing operation may be indicated.

The Spectrum of Radiographic Findings in Antibiotic-Related Pseudomembranous Colitis

The radiographic findings in pseudomembranous colitis related to antibiotic therapy have previously been considered nonspecific and indistinguishable from those seen in other acute ulcerating colitides. A review of 9 such patients evaluated over a period of 6 months suggests a range of radiographic abnormalities including, in severe cases, an appearance which is strongly suspicious of this condition and may be diagnostic. While proctosigmoidoscopy is the preferable diagnostic tool, the barium enema will frequently precede it, enabling the radiologist to suggest the diagnosis. Early recognition is important, as this condition carries a significant morbidity unless the offending antibiotic is discontinued.

Staining of Parathyroid Adenomas by Selective Arteriography

LOCALIZATION of parathyroid adenomas by arteriography was originally described by Seldinger (8) in 1954. Recent reports (2, 5, 7, 8) have stressed displacement of the cranial and caudal loops of the inferior thyroid artery as the principal arteriographic sign. With this sign, successful preoperative localization has been achieved in 66 per cent (7, 8) down to 0 per cent (4) of cases studied. These “localizations” based on displacement are really “lateralizations” without specific identification of the abnormal parathyroid. Our preliminary findings with this technic indicated that such displacements were often inadequate, especially in patients with previous neck explorations and persistent hyperparathyroidism. This small but important group, for whom an accurate localizing technic would be most beneficial, included the ones most likely to show falsepositive vascular displacements. Although staining of parathyroid adenomas during arteriography has been reported previously (1, 3, 6, 7, 10, 11), this diagnos...

The roles of gallium-67 scintigraphy, ultrasonography, and computed tomography in the detection of abdominal abscesses

The evaluation of patients with suspected abdominal abscesses begins with a history and careful physical examination. Gallium-67 (67Ga) scintigraphy, ultrasonography (US), and computed tomography (CT) are utilized only after other routine investigations have failed to localize the abscess. All three modalities are reliable for the detection of abdominal abscesses. The decision regarding which of these three diagnostic tests to use in a particular patient rests upon clinical considerations. If the patient has acute localizing signs and symptoms, 67Ga should not be used initially. In this type of patient, rapid diagnosis is best provided by either US or CT. Further radiologic investigation may be terminated if the CT or US findings are characteristic of an abscess. A 67Ga scan should be performed in a patient with acute localizing signs and symptoms if the initial CT or US is negative. In a patient with nonlocalizing signs and symptoms, 67Ga imaging should be employed as the first procedure since the entire body is easily surveyed. If the 67Ga images are abnormal, then CT or US should be utilized for further lesion characterization. This diagnostic approach will optimize the rapidity of patient evaluation and will minimize diagnostic errors.

Calcification in an Angiomyolipoma: A Case Report

A patient with tuberous sclerosis and angiomyolipoma of both kidneys is described in whom both tumors demonstrated associated calcification. This finding has not been previously stressed in the literature and is important in that ignorance of its occurence in this tumor might result in an error of diagnosis and nephrectomy in a patient who can ill-afford the loss of renal parenchyma.

Cholecystosonography: Accuracy, Pitfalls and Unusual Findings

Gray scale cholecystosonograms in 200 patients were reviewed. The findings in 133 of the patients were proved correct at surgery or autopsy. The overall accuracy for the detection of gallstones was 92 percent, with a false-negative rate of 4 percent. A false-positive diagnosis of cholelithiasis was made in three patients, two of whom proved to have extensive cholesterolosis. Causes of false-negative studies were the presence of a single small calculus, obseity and a large distended gallbladder. Ultrasound was specific but insensitive in the detection of a thickened gallbladder wall. The significance of a nonvisualized gallbladder by ultrasound and the role of ultrasound in the diagnosis of gallbladder disease are discussed.

spectrum of sonographic findings in infantile polycystic kidney disease with urographic and clinical correlations

We evaluated nine patients, age 1 day to 17 years, having infantile polycystic kidney disease (IPKD). Using modern scanners with 5‐MHz transducers we have observed two previously unemphasized sonographic (US) findings, a peripheral zone of normally echogenic cortex (five patients), and mild caliectasis (two patients). Our data suggest that IPKD is a more heterogeneous condition clinically and sonographically than generally appreciated and that presence of a thick normally echogenic renal cortex is a good predictor of concurrent normal renal function and prolonged survival.

A Comparison of Three Cholecystographic Agents A Double-Blind Study With and Without a Prior Fatty Meal'

A double-blind technique was used in testing three cholecystographic agents in 726 patients. Graded scoring of radiographs, percentage of diagnostic first-day studies, and incidence of adverse effects were evaluated. In the fat-free group, a 4.5 g dose of iocetamic acid (Cholebrine) produced the most dense shadows and highest diagnostic yield and iopanoic acid (Telepaque) the least dense and lowest diagnostic yield. The difference in density and diagnostic yield between tyropanoate sodium 3.0 g (Bilopaque) and iocetamic acid 4.5 g was not statistically significant. A fatty meal significantly increased density and diagnostic yield of iopanoic acid and appeared to improve its absorption.

The Colitis of Behcet's Disease: A Clinical-Radiographic Correlation

The radiographic, colonoscopic, and pathologic findings in this case of Behcets colitis differ completely from ulcerative or granulomatous colitis as well as from other, less commonly seen inflammatory colitides. Discrete, peptic-type ulcers, with normal intervening mucosa and normal overall configuration of the colon, are seen on radiography and endoscopy. The angiographic features are not diagnostic but differ considerably from findings in other inflammatory colitides. No tortuous arterioles, mucosal hyperemia or early venous filling was encountered.