Jeffrey D. Wicks

Chest X-rays and full lung tomograms in gynecologic malignancy.

Four‐hundred‐seventy‐one patients with gynecologic malignancy were studied. All of these had chest x‐rays at the time of staging and 323 had concurrent full lung pleuridirectional tomography performed. In no instance were pulmonary parenchymal metastases identified by tomograms when the chest x‐ray was negative and tomography led to more equivocal readings than did the chest x‐ray. The current study indicates that there is extremely low diagnostic yield of full lung tomography in gynecologic malignancies. Full lung tomography was poor in assessing the presence of small pleural effusions. The yield of positive chest x‐ray at varying follow‐up times was also examined. The yield has been expressed by site of origin of the tumor as well as by stage at initial diagnosis. Some of these yields are quite high. There is a very poor prognosis when pulmonary findings become evident, regardless of the site of origin of the tumor. More than one half of the patients who develop pulmonary abnormalities will be dead within one year.

Intraspinal, extradural ependymoma.

Extradural ependymoma is a rare tumor arising most commonly in the soft tissues of the presacral area, less commonly in the soft tissues of the sacrococcygeal region dorsal to the sacrum, and rarely in the extradural portion of the spinal canal. The differential diagnosis varies with the location, but the natural history of the tumor is the same. If the tumor is not completely excised at surgery, it may recur. Distant metastases have been reported. A case of an extradural ependymoma arising within the spinal canal is reported with myelographic and computed tomographic findings at diagnosis and after therapy.

Utility of radionuclide liver/spleen scanning and serum enzyme level in detecting hepatic metastases from ovarian carcinoma.

One‐hundred‐five patients with ovarian carcinoma had radionuclide liver/spleen scanning done at the time of staging. Of the 105 initial scans, eight were interpreted as having hepatocellular dysfunction. Seven of these eight had abnormal liver function studies. One patient had a hepatic cyst but had elevated liver function studies. Six patients demonstrated hepatic metastases (at the time of staging). All but one of these occurred in Stage IV tumors of epithelial origin (adenocarcinoma). No hepatic metastases were demonstrated in Stage I or II tumors, and only one Stage III epithelial carcinoma had hepatic metastases. Three patients developed hepatic metastases during the course of treatment. All nine patients with hepatic metastases had abnormal concurrent liver function studies. It is suggested that screening for liver metastases in patients with ovarian carcinoma is of limited value in patients with normal liver function studies.

Diagnostic imaging of choledochal cysts.

A review of the literature concerning the diagnostic accuracy of various imaging modalities for choledochal cysts indicates that both ultrasound and scintigraphic methods have approximately 80% accuracy. Oral cholecystography and intravenous cholangiography methods have between 60 and 80% accuracy. Ultrasound is recommended as the initial preoperative test of choice, with hepatobiliary scintigraphy or CT scanning being most useful for postoperative evaluation.

Co-existent renal eosinophilic granuloma and renal adenocarcinoma

Localized renal eosinophilic granuloma has not been previously reported. In this patient there was osseous eosinophilic granuloma and a 1 cm hypervascular renal lesion which pathologically proved to be coexistent renal adenocarcinoma and eosinophilic granuloma.

Use of ultrasound in renal hypertension.

Ultrasound provides a noninvasive, sensitive, and accurate method of evaluating the kidneys in hypertensives. Although specific histologic diagnoses cannot be made, patients can be classified based on renal size and parenchymal pattern. This information is especially helpful in azotemic patients with hypertension.

Sonography of adrenal lesions causing hypertension

The techniques and applications of diagnostic ultrasound in patients with hypertension due to adrenal abnormalities are reviewed. Sonographic findings and comparison with other imaging modalities are discussed.

Ascites causing a false-positive radionuclide liver image

False-positive radionuclide liver images can occur due to impingement on the liver by adjacent normal anatomic structures or adjacent pathologic masses or fluid collections. A patient with ascites in the anterior subphrenic space had an apparent “cold” lesion in the left lobe of the liver. Ultrasonography demonstrated a normal left lobe and localized the fluid collection.