Harold B. Spitz

Small Bowel Intussusception Demonstrated by Oral Barium

Abstract Renewed interest in the use of oral barium for evaluating small bowel obstruction has resulted in more accurate delineation of the site and cause of the obstruction. The authors report 4 cases of small bowel intussusception studied roentgenographically with oral barium. The causes, symptoms, and consequences of intussusception, as well as the incidence and location of the lesions, are discussed. Roentgen signs, utilizing the oral approach, are re-emphasized, and comparison is made with the more common findings of intussusception demonstrated by barium enema study.

Right Atrial Contour in Cardiac Tamponade

Abstract In 6 of 9 patients with pericardial tamponade, angiography showed the inner border of the right atrial wall to be concave. The same atrial border was straight in 2 patients with constrictive pericarditis and convex in 4 with pericardial effusion without tamponade. The tamponade appearance was reproduced in 4 dogs in which acute pericardial tamponade was induced. It is believed that the increased pressure of the pericardial fluid compresses the thin-walled right atrium when the pericardium is no longer able to distend.

The Abdominal Fat Necrosis Sign

The fat necrosis sign is pathognomonic of acute pancreatitis. It can be recognized roentgenographically by faint mottled radiolucencies, probably representing normal fat interspersed with the water density of hydrolyzed or saponified fat. The sign is probably often associated with a precipitous drop in the serum calcium level as a result of mobilization of calcium into the necrotic areas in the form of calcium soaps. Although rare, this sign is diagnostic of acute pancreatitis with a high mortality rate.