James L. Clements

Carcinoid of the duodenum: a report of six cases.

Duodenal carcinoid tumors are rare. Six cases of primary duodenal carcinoid tumors are presented. Analysis of these cases indicates that the radiographic appearance can vary from a benign-appearing intramural submucosal mass lesion to a large bulky ulcerating lesion. All cases in this series followed a benign course. One patient has survived over 30 years with proven regional and hepatic metastases. This patient showed regression of the duodenal lesion following embolization for control of severe hemorrhage.

Pancreatic disease simulating urinary tract disease

Pancreatic pseudocyst may encroach directly on a kidney and ureter, and present symptoms and radiological changes suggestive of a primary urinary tract lesion. The possibility of pancreatic pseudocyst should be considered in differential diagnosis of atypical avascular mass lesions of the kidney and in abdominal masses in the presence of signs of renal disease. Three cases of renal involvement simulating intrinsic renal disease on intravenous urography are presented. In two of them, arteriographic studies suggested primary renal disease. A fourth case showed ureteral displacement simulating a large retroperitoneal mass lesion. Various radiologic procedures in evaluating pancreatic pseudocyst are briefly discussed. It is emphasized that even with more sophisticated angiographic procedures, diagnostic pitfalls in the differentiation of pancreatic from renal disease remain.

Atypical Esophageal Diverticula Associated with Progressive Systemic Sclerosis

Five cases of unusual esophageal diverticula associated with progressive systemic sclerosis (scleroderma) or collagen vascular disease are presented. These wide-mouthed saccular diverticula were infrequently seen in a group of PSS patients with the typical motility disturbance of esophageal involvement and are reminiscent of the diverticula of the colon involved by PSS.

The multi-channelled pylorus

The entity of multiple pyloric channels may be congenital but the majority are acquired lesions representing fistulae secondary to peptic ulcer disease in the pyloroduodenal region. The fistula usually joins the lesser curvature of the stomach with the superior aspect of the duodenal bulb. The multichannelled pylorus produces a characteristic radiological appearance on barium mean examination with a double or split barium column in the region of the pylorus. Four cases are described and illustrated.

Corrugated mucosal pattern in the esophagus associated with progressive systemic sclerosis

Three cases of unusual corrugated mucosal pattern in the esophagus accompanying the typical motility disturbance of progressive systemic sclerosis (PSS) are reported. The changes were rarely seen in a group of patients with esophageal involvement by PSS.

Gastric Pseudo-Ulcers: Membrana Angularis and Pyloric Torus Defects

The membrana angularis and pyloric torus defects are two physiologic bulges which can simulate ulcerations along the lesser curvature of the stomach. The muscular anatomy of the stomach and the mechanism which produces these pseudo-ulcers are discussed. Both pseudoniches can be seen transiently in normal individuals but occasionally are such prominence as to become diagnostic pitfalls. The features and significance of each pseudo-ulcer are reviewed in an attempt to facilitate recognition on the upper gastrointestinal barium examination.

Complications of Intestinal Surgery

Radiologic examination of the abdomen plays an important role in the diagnosis and management of postoperative complications of surgery of the small bowel and colon. Plain films of the abdomen in supine and erect positions are usually the first examination, often followed by barium contrast studies of the small intestine and colon, in a patient with suspected intraabdominal disease occurring as the result of recent or remote surgical procedure on the small bowel and colon. Recently, the more sophisticated methods of imaging such as abdominal ultrasound and abdominal computed tomography have added a new dimension to the evaluation of intraabdominal diseases.