James M. Halls

Double-contrast barium meal and upper gastrointestinal endoscopy. A comparative study.

One hundred randomly selected inpatients were examined with both double-contrast barium meal and endoscopy in a blinded prospective fashion. All studies were done by staff personnel, with equal clinical information available to both the radiologist and endoscopist. The final diagnosis was made by a review committee of participating radiologists and endoscopists. Endoscopy was more sensitive (92% versus 54%, p less than 0.001) and specific (100% versus 91%, p less than 0.05) than the double-contrast barium meal. Both procedures significantly affected the clinical outcome of the patient, the effect of endoscopy being significantly greater than that of the double-contrast barium meal. Although errors with the barium study related predominantly to an inability to show subtle lesions, poor patient cooperation and perceptual and technical failures were additional significant factors. Endoscopy is recommended for certain groups of patients.

Renal biopsy-related hemorrhage: frequency and comparison of CT and sonography

To evaluate the frequency of retroperitoneal hemorrhage related to renal biopsy, we prospectively assessed 182 patients (200 biopsies) using state-of-the-art CT and ultrasound. Our study revealed definite CT evidence of hemorrhage after 90.9% of biopsies. In a blinded analysis of images obtained in biopsied patients and in unbiopsied control patients the overall accuracy of CT was 93.8 versus 76.4% for ultrasound. Our data suggest that detectable hemorrhage is virtually always seen after renal biopsy and its frequency is much higher than noted in earlier studies.

Gray-Scale Ultrasonography of Hepatic Amoebic Abscesses

Retrospective analysis of the ultrasonograms of 42 hepatic amoebic abscesses in 34 patients was performed. All lesions were less echogenic than normal liver. All but 1 were contiguous with the liver capsule and had slight distal sonic enhancement. Twenty-three were predominantly homogeneous with fine, low-level echoes. This pattern is highly suggestive of hepatic amoebic abscess. Nineteen abscesses did not show this pattern and could not be diagnosed based on ultrasonographic criteria.

Magnetic resonance imaging of bone after radiation

Magnetic resonance imaging (MRI) was performed in 22 patients at various times (0-3) years) following radiation therapy to the spine. T1 and T2 weighted images were obtained at 0.5 Tesla. Increased signal was seen after 800-6000 rads (8-60 Gy). Marrow effects corresponded to radiation ports. Recurrent tumor was clearly separated from fatty replacement. This was much better seen on T1 weighted images. Five patients that had MRI during their course of radiotherapy (XRT) did not have increased signal on T1 images of the bone marrow. The earliest fatty marrow change was seen nine days following completion of 3000 rads (30 Gy) XRT over one months duration. One patient who received 800 rads (8 Gy) to the upper thoracic spine for eosinophilic granuloma had no radiation effects on MRI when imaged 16 days following completion of XRT given over five days. Fatty marrow change was seen in this patient on MRI six months later. MRI was particularly useful in defining the extent of prior radiation effects when repeat therapy was needed.

Computed Tomography of Benign Cystic Teratoma of the Omentum

Benign cystic teratoma of the omentum is a rare gynecologic condition. No cases have been diagnosed preoperatively; six cases have been reported in association with an ovarian teratoma. We report a seventh case in which ultrasound and CT were used preoperatively.

Cecal volvulus: A complication of colonoscopy

Colonoscopy is a widely used procedure with low morbidity and mortality. A case of cecal volvulus following colonoscopy is presented. This potentially lethal complication should be considered in patients with persistent abdominal pain following colonoscopy because it is easily diagnosed radiographically and requires emergency surgical intervention.

Enterogastric reflux in suspected acute cholecystitis.

Ninety patients undergoing Tc-99m disofenin hepatobiliary scintigraphy for suspected acute cholecystitis were assessed for enterogastric reflux. Seventy-seven cases showed bowel activity by one hour and were included in the study. Twenty-six percent (20/77) showed definite enterogastric reflux. The gastric activity tended to clear rapidly, even though patients remained supine during examination. Six of 20 patients (30%) with enterogastric reflux had gallbladder visualization. Of these six, one had acute cholecystitis and one had resolving acute cholecystitis with gallstone pancreatitis. There was one case each of pancreatitis, amebic abscess, sepsis, and one normal. Thus, of 20 patients with enterogastric reflux, 16 had acute cholecystitis (80%). Twenty-three of seventy-seven patients (30%) had surgically proven acute cholecystitis: of these, 16 of 23 (70% sensitivity) had gastric reflux, and 50 of 54 without acute cholecystitis did not have reflux (93% specificity). The overall accuracy of enterogastric reflux for acute cholecystitis is 86%. Gastric reflux seen on cholescintigraphy is a secondary sign of acute cholecystitis. Reflux may be related to duodenal irritation from the adjacent inflamed gallbladder.

Ct Demonstration of Intrathoracic Thyroid Tissue

Abstract Three cases of multinodular goiter with intrathoracic extension are presented. The intrathoracic portions simulated other mediastinal masses. which resulted in surgical intervention in one case.

Hepatobiliary scintigraphy and scintiangiography in abdominal trauma.

Scintiangiography and hepatobiliary scintigraphy were performed in 45 patients with abdominal trauma. There were 18 gunshot wounds, six stab wounds, and 21 blunt injuries. Thirty-one of 45 patients showed abnormalities (69%). There were nine bilomas (4 with leaks), three leaks without biloma, (7 total leaks), five liver hematomas, three liver infarcts, one liver abscess, four renal injuries, one post-traumatic hepatic artery aneurysm, one acute acalculus cholecystitis, and four bowel injuries including one fistula, two obstructions, and one stricture. Two of the renal injuries and the hepatic artery aneurysm were identified only during scintiangiography. Eighteen of 38 gallbladders were not visualized despite normal bowel transit and delayed views to 4 hours (47%). Fourteen of 16 gallbladders were grossly normal at surgery, one had gallstones, and one had post-traumatic acalculus cholecystitis (6%). Hepatobiliary scintiangiography showed unique characteristics of vascular and renal lesions that were not seen on routine images. Sulfur colloid had no advantage over disofenin in evaluating liver injuries in nine cases. A high percentage of nonvisualized gallbladders (47%) were noted in acutely traumatized patients, and caution is recommended in diagnosing acute cholecystitis in the face of trauma.

Tumor thrombosis of the inferior vena cava due to retroperitoneal germ cell tumor

Three patients (2 males and 1 female), aged 17–28 years, with tumor thrombosis of the inferior vena cava due to retroperitoneal germ cell tumor are reported. Diagnostic and therapeutic implications of this condition are discussed.