I.P. Wells

Percutaneous drainage in emphysematous pyelonephritis — an alternative to major surgery

Emphysematous pyelonephritis is a rare, life-threatening infection of the kidney associated with the production of gas, usually found in diabetic patients. Experience of this condition reported in the literature suggests that vigorous medical treatment and early nephrectomy are advisable. We report a case in which percutaneous renal drainage combined with medical therapy produced not only complete recovery of the patient, but also preservation of renal function on the affected side.

The distribution of pulmonary shadowing in farmer's lung

Reports of the radiological features in farmers lung are inconsistent. We have reviewed clinical and radiological findings in eight patients with farmers lung in the acute and sub-acute phases. In the acute phase the main feature is transient widespread diffuse shadowing of air space consolidation. In the sub-acute phase, the predominant feature is fine nodular shadowing tending to involve either the upper half or upper two-thirds of the lungs with relative sparing of the basal segments. This is in accordance with both the pathophysiological behaviour of the inhaled particulate antigen and the subsequent distribution of pulmonary changes in chronic farmers lung.

The effect of radiology guidelines for general practitioners in plymouth

The impact of introducing guidelines to General Practitioners using the radiodiagnostic services in the Plymouth Health District has been analysed. The guidelines were advisory and issued to all General Practitioners in the area served by the Plymouth group of hospitals. There was no vetting of requests from Practitioners following their introduction. Three 6 month periods were considered; two before the guidelines were introduced and one after. An overall reduction of 23% in referrals was achieved. An analysis by examination showed that only those examinations specifically targeted in the guidelines showed a significant reduction. In the case of targeted examinations, a reduction of 28% (P less than 0.001) was demonstrated.

Pseudoaneurysm of the Internal Mammary Artery as an Unusual Cause of Post-sternotomy Hemorrhage: The Role of Multislice Computed Tomography in the Diagnosis and Treatment Planning

Pseudoaneurysm of the internal mammary artery (IMA) following median sternotomy is extremely rare. To date, the reported cases are only in single figures. The majority of these pseudoaneurysms were suspected from the clinical presentation, echocardiography or computed tomography (CT) but were only confirmed on contrast angiography. This case report demonstrates the current ability to carry out detailed vascular imaging on a 16-slice CT scanner. This accurate delineation of the pseudoaneurysm allowed targeted therapeutic embolization to be performed without unnecessary angiographic imaging.

Endovascular Embolization of Varicoceles: Resorption of Tungsten Coils in the Spermatic Vein

AbstractPurpose: To investigate whether resorption of tungsten coils occurs in patients with varicoceles treated by endovascular embolization of the spermatic vein. Methods: Patients who had previously had varicocele embolization were requested by letter to attend the radiology department. Blood levels of tungsten were compared with a group of controls. Fluoroscopic images of the coils were taken and compared with those obtained during the original procedures. Results: Nineteen patients attended, whose procedure had been done 19–57 months previously (mean 40 months). Blood levels of tungsten were raised in 18 patients compared with the controls. Radiographic evidence of loss of substance of the coils was seen in four patients. Conclusion: Tungsten coil resorption occurs in varicocele embolization. In view of the unknown long-term effects of raised blood tungsten levels and the availability of alternative embolization agents, we feel that it is unwise to persist in the use of tungsten coils in this application.

The Effect of Reporting Speed on Plain Film Reporting Errors

AIM To determine whether reporting plain films at faster rates lead to a deterioration in accuracy. METHODS Fourteen consultant radiologists were asked to report a total of 90 radiographs in three sets of 30. They reported the first set at the rate they would report normally and the subsequent two sets in two thirds and one half of the original time. The 90 radiographs were the same for each radiologist, however, the order was randomly generated for each. RESULTS There was no significant difference in overall accuracy for each of the three film sets (p=0.74). Additionally no significant difference in the total number of false-negatives for each film set was detected (p=0.14). However, there was a significant decrease in the number of false-positive reports when the radiologists were asked to report at higher speeds (p=0.003). CONCLUSIONS When reporting accident and emergency radiographs increasing reporting speed has no overall effect upon accuracy, however, it does lead to less false-positive reports.

Embolisation of hypernephromas: A simple technique using ethanol

Experience of the embolisation of hypernephromas with 95% ethanol is described in 10 patients. An initial technique using 95% ethanol diluted with contrast has been modified. A single injection of 15 ml of undiluted 95% ethanol through a balloon occlusion catheter is now recommended. We conclude that this is a quick, easy and safe method of embolising hypernephromas.

Case report: Structural failure of a Bird's nest inferior vena caval filter

At routine follow-up 13 months after its insertion, a Birds nest inferior vena caval filter was found to be broken. The radiological findings are presented. This is the first reported case of structural failure in this sort of filter.

Long-term follow-up of the antheor inferior vena cava filter

The first long-term follow-up of the use of the Antheor inferior vena cava (IVC) filter is presented. Between December 1994 and December 1996, 20 Antheor IVC filters were inserted. Seven patients subsequently died and of the 13 patients remaining alive, 11 were available for long-term follow-up. One death was due to migration of the filter to the main pulmonary artery 6 weeks after insertion and because of this case, and other similar reports, the filter has now been withdrawn from clinical use. Of the 11 filters assessed at follow-up, three were fractured. One filter contained thrombus and one IVC was occluded. Our experience highlights the problem of central migration, but also shows a high incidence of filter fracture which has not previously been described with this design of filter.

Bolus chasing: A new technique in peripheral arteriography

Recent advances in digital angiographic equipment design have enabled a new technique of peripheral arteriography involving digital bolus chasing to be developed. This technique permits real-time visualization of the contrast bolus so that it can be followed peripherally with digital images being acquired at a suitable frame rate. We give the first description of this technique using the Philips Integris C2000 and compare it to conventional stepped arteriography. Sixty-one patients undergoing peripheral arteriography using the conventional stepped technique were compared with 55 patients using bolus chasing. The parameters assessed were the procedure time, the number of runs and screening time per investigation, the consumables used, the patient and radiologist radiation dose and the image quality. A reduction in the procedure time and the patient and radiologist radiation dose, and improvement in image quality are demonstrated with the bolus chasing technique. Bolus chasing represents an important advance in peripheral arteriography.