Hubert C. Meredith

Obstructive jaundice caused by cavernous transformation of the portal vein

Extrahepatic portal obstruction developing in the neonatal period usually presents with manifestations of portal hypertension. Obstructive jaundice has not previously been described as a complication of this condition. A 22 year-old white male presented with jaundice, decreased appetite and tiredness for six months. He was known to have portal hypertension which followed neonatal omphalitis and portal vein thrombosis. At age four, splenectomy and lieno-renal shunt was done because of bleeding from oesophageal varices. Two further, self-limiting episodes of gastrointestinal bleeding occurred in his teens. He was normally developed and showed no other abnormalities apart from jaundice. Total bilirubin was 10.4 mgm % with a direct fraction of 7.2 mgm%. Alkaline phosphatase was elevated to 344 K.A. units, but liver function tests were otherwise normal. Liver biopsy was unsuccessful, but was complicated by puncture of the gall-bladder with haemorrhage into it, necessitating laparotomy. The wall of the gallblad...

Hiatal hernia complicated by gastric ulceration and perforation

The incidence of gastric ulcer in hiatal hernia is highest in para-esophageal hernia and in chronic incarcerated hernia in older patients. Two patients with chronic incarcerated sliding hernias complicated by unrecognized gastric ulcération and perforation are described. One patient developed a subhepatic and mediastinal abscess; the other developed a gastropleural fistula. The incidence, clinical and roentgen findings, complications, and treatment of gastric ulcers in hiatal hernia are discussed.

Osler Revisited: An Unusual Cause of Inversion of the Diaphragm

Osler described depression of the left hemidiaphragm and left lobe of the liver as a physical finding in some patients with pericardial effusion. Inversion of the left hemidiaphragm associated with a large pericardial effusion is an unusual, previously unreported complication. It may be a contributory factor in the production of unexplained dyspnea in some patients.

Pneumoarthropathy: An Unusual Radiographic Sign of Gram-Negative Septic Arthritis

Gas in the joint and periarticular tissues appeared as an early radiographic manifestation of gram-negative septic arthritis of the hip in a diabetic patient. The features of gram-negative septic arthritis are discussed and the value of an early diagnosis is emphasized.

Antral and esophageal rimple: a normal variation.

The occurrence of fine antral and esophageal rimpling appears to be the result of contractions of the muscularis mucosa. The lack of persistence during distention is compatible with this conclusion. The folds have no pathologic significance.

Angiographic demonstration of gastrointestinal bleeding through the pancreatic duct

This article describes the angiographic findings in the case of a bleeding stump of the left gastric artery, following subtotal gastrectomy, into a pancreatic pseudocyst with instantaneous opacification of the pancreatic duct and duodenum. This is the first reported case to demonstrate a frank bleed with total opacification of the pancreatic duct. Based on our experience and previously reported cases, we conclude that subselective catheterization of the bleeding vessel is necessary to demonstrate total opacification of the pancreatic duct in such cases.

The silhouette sign and the inferior vena cava.

Pulmonary lesions causing obliteration of the normal inferior vena cava (IVC) shadow on the lateral radiograph are described. Retrocardiac mediastinal mass lesions and subpulmonic pleural effusions may also obliterate the IVC contour. Loss of the IVC shadow is an additional radiographic sign of right lower lobe collapse and frequently of disease involving the medial basal segment of the right lower lobe. This finding should be an indication that further investigation is needed to explain the loss of normal aeration.

The skull in renal osteodystrophy

The skull radiographs of 68 patients undergoing dialysis for chronic renal failure were reviewed for evidence of renal osteodystrophy. Four patients (6%) were positive and the unusually severe changes seen in one patient are described in detail. The changes seen in the skull in renal failure, both before and after treatment, are discussed.

The vascular ‘sunburst’ appearance of osteosarcoma: A new angiographic finding

The angiographic analogue of the ‘sunburst’, (right angle) periosteal new bone formation in osteogenic sarcoma is described. The angiographic findings in this tumor and their relationship to the pathologic appearance are discussed.

Portal vein ectasia simulating a vascular lesion in the pancreatic head in an enhanced CT scan

An ectatic portal vein in a patient with portal hypertension and chronic active hepatitis simulated a vascular lesion in the head of the pancreas in a contrast-enhanced CT scan.