Harvey L. Neiman

The Spectrum of Radiologic Findings in Allergic Bronchopulmonary Aspergillosis

Early diagnosis of allergic bronchopulmonary aspergillosis (ABPA) is important. Initiation of corticosteroid therapy in ABPA is essential to prevent progressive destruction of lung parenchyma. The earliest radiographic manifestations of the disease may be present only on bronchograms. In addition to the classic radiographic findings (infiltrate, massive homogeneous consolidation, tram-line shadow, parallel line shadow, ring shadow, toothpaste shadow, glove-finger shadow), perihilar infiltrates simulating adenopathy (pseudohilar adenopathy) and air fluid levels were frequently demonstrated.

Computed vs. Conventional Tomography in Evaluation of Primary and Secondary Pulmonary Neoplasms

One hundred patients, ultimately proved to have chest malignancies, were evaluated prospectively with conventional chest tomography and computed tomography. In 58 patients with primary malignancies, conventional tomograms were more useful in evaluation of the hilus than CT scans. The mediastinum was better assessed by CT. Thus, evaluation of the presence of neoplasia is better accomplished by conventional examination, while extent of disease is best assessed by CT. Thoracotomy for curative resection was not attempted (in the latter cases of this series) based on CT findings of mediastinal involvement. In 42 patients with metastases to the chest, CT scans of the lung parenchyma were more sensitive than whole lung tomography but had little additional impact on patient treatment. Nevertheless, in 18 patients the results of CT or whole lung tomography directly affected patient therapy.

Estimation of Prostatic Size by Suprapubic Ultrasonography

Previous ultrasonic scanning of the prostate primarily has involved the transrectal approach. In this study the suprapubic approach was chosen because it uses basic ultrasound equipment and is atraumatic. In 29 patients undergoing prostatectomy there was a highly significant correlation (r equals 0.95) between the prostatic weight determined by this method and the postoperative weight of the adenoma.

Angiographic evaluation of pancreatic disease. A further appraisal.

Reappraisal of pancreatic angiography among 76 proved cases involving normal studies and those demonstrating pancreatic neoplasms and pancreatitis reaffirms conclusions drawn from a prior series from this institution. Differentiation of the normal and abnormal pancreas was accomplished in 92% of cases. Angiographic abnormality was present in 97% of pancreatic carcinomas and confident differentiation of carcinoma from pancreatic inflammatory disease was possible in 85% of cases. Subselective angiography, magnification techniques, and pharmacoangiography significantly improved diagnostic confidence and accuracy, particularly in patients with small tumors or pancreatitis. In addition to its diagnostic value, a major benefit of pancreatic angiography lies in its ability to predict tumor resectability in the majority of patients.

Computed Tomography of Retroperitoneal Castleman Disease (plasma Cell Type) with Sonographic and Angiographic Correlation

The CT and sonographic appearances of a case of retroperitoneal Castleman disease of the plasma cell type are reported along with angiographic correlation. In this case CT demonstrated a minimally calcified homogeneously enhancing retroperitoneal mass. Sonography showed the mass to be hypoechoic with good through transmission. The lesion was hypervascular with prominent early venous drainage on inferior mesenteric arteriography.

The ultrasonographic characterization of tendons

Ultrasonography has not been utilized in the diagnosis of musculoskeletal disorders. However, the superficial location of tendons and ligaments lend themselves to evaluation by this modality. The ultrasonographic characteristics of the normal Achilles tendon are described in both the rabbit and man. The characteristic ultrasonographic findings after injury to the Achilles tendon are also determined. This imaging technique provides a sharp definition of the tendon and surrounding structures and easily demonstrates abnormalities. The superficially located quadriceps tendon is also well visualized by ultrasound and representative examples are shown. Ultrasound should be considered as another useful method for evaluation of these superficial musculoskeletal structures.

The Natural History of Simple Renal Cysts: A Preliminary Study

We examined the natural history of simple renal cysts in 59 patients followed periodically with renal ultrasonography. Using the parameters of cyst diameter and number we grouped the patients according to the differing natural history of the cystic lesions. The results indicate that simple cysts tend to progress in number rather than size. Furthermore, 3 patients had independent solid or complex lesions. The only patient explored had an adenocarcinoma of the kidney. Periodic reevaluation of patients with an ultrasonic diagnosis of simple renal cyst warrants serious consideration.

Value of computed tomography in the detection of complications of Crohn's disease

Abdominal and pelvic computed tomography (CT) scans were performed on 17 patients with suspected complications of Crohns disease. CT was superior to conventional barium studies and colonoscopy in demonstrating mural, serosal, and mesenteric pathology such as bowel wall thickening (100%), abscess (59%) and phlegmon (6%) formation, and fibrofatty proliferation of the mesentery (41%). While not advocated as the primary means of evaluating Crohns disease, CT can provide information vital to the management of complications of this disease.

Ultrasound Identification of Impalpable Testicle Tumor

We describe an ultrasound technique that accurately detected an occult testicular primary in a young man with a large retroperitoneal seminoma. A simple water bath system and commonly available ultrasound equipment are used to provide high resolution scans and excellent patient acceptance.

Gray-Scale Ultrasound Diagnosis of Peripheral Arterial Aneurysms

Diagnostic ultrasound is a feasible technique for demonstrating the presence of an aneurysm in the popliteal, femoral, iliac, and brachial arteries. All aneurysms were correctly identified and confirmed by arteriography, surgery, or examination of the amputated specimen. The popliteal artery in healthy volunteers had a mean size of 0.8 +/- 0.2 cm. Neither the age nor the sex of the patient influenced artery size. In patients with known abdominal aortic aneurysms of significant atherosclerosis, the popliteal size was within two standard deviations from the mean of normal popliteal arteries.