Jerome F. Wiot

Defects of the Renal Collecting Systems in Patients Receiving Anticoagulants

Four patients receiving oral anticoagulants had symptoms including flank pain and gross hematuria suggesting renal calculi. Excretory urography revealed diffuse infundibular narrowing and intramural filling defects of the renal pelvis and proximal ureters. In all cases the urograms returned to normal and the symptoms were remitted after the prothrombin activity level was increased. The changes probably represented submucosal hemorrhage. The major importance of this entity is its recognition as a relatively benign and easily remediable complication of anticoagulant therapy.

Roentgen findings in obstructed diaphragmatic hernia.

As one reviews the rather extensive literature concerned with obstructed diaphragmatic hernia, it becomes evident that there has been considerable difficulty in making this diagnosis. Yet our own experience indicates that it can be promptly established roentgenologically if certain basic facts and principles are kept in mind. The importance of early recognition of this condition cannot be overemphasized, since strangulation and other serious sequelae so often supervene that in untreated cases the mortality approaches 90 per cent (19). Obstruction may complicate any type of diaphragmatic hernia (3, 20). It is relatively rare, however, in right-sided traumatic hernia since the liver generally prevents the gut from entering the chest (14). The present discussion will be limited to hiatal and traumatic hernia of the left hemi-diaphragm, the two most common types, but the roentgen signs to be described are applicable as well to hernias through the other orifices. Obstructed diaphragmatic hernia is not rare. Su...

The cervicothoracic continuum.

The anatomic communications between the neck and the mediastinum are described. Anatomic sections and drawing are used to demonstrate the normal compartments, their fascial envelopes, their contained structures, and their interrelationships. Selected cases are used to illustrate the spread of pathologic processes within the cervicothoracic region.

Small Bowel Intussusception Demonstrated by Oral Barium

Abstract Renewed interest in the use of oral barium for evaluating small bowel obstruction has resulted in more accurate delineation of the site and cause of the obstruction. The authors report 4 cases of small bowel intussusception studied roentgenographically with oral barium. The causes, symptoms, and consequences of intussusception, as well as the incidence and location of the lesions, are discussed. Roentgen signs, utilizing the oral approach, are re-emphasized, and comparison is made with the more common findings of intussusception demonstrated by barium enema study.

RETROGRADE VERTEBRAL ARTERY BLOOD FLOW. A NORMAL PHENOMENON.

Reversal of vertebral arterial flow associated with proximal subclavian artery occlusion has been well documented (2, 5, 7, 11, 20, 22). The terms “subclavian steal syndrome” and “brachial-basilar insufficiency” have been used in reference to this association and are descriptive of the hemodynamic alterations which occur. We have encountered two additional groups of patients in whom retrograde flow of contrast medium in a vertebral artery was not associated with proximal innominate or subclavian arterial stenosis or occlusion. In view of the recent interest in the subclavian steal phenomenon, it is important to recognize that retrograde vertebral flow of contrast medium during angiography may occur as a normal variant. We have been unable to find any previous authentication of this finding in the literature. Material Arteriographic studies of the great vessels have been performed at the University of Cincinnati Medical Center in 120 patients with significant signs and/or symptoms of cerebrovascular ischem...

Postoperative Pneumoperitoneum in Children

Is free intraperitoneal air in the postoperative patient a residual of the operative procedure, or does it indicate a perforation or disruption of an anastomosis? This is a problem that has often plagued both radiologists and surgeons for, generally, postoperative abdominal films are obtained only when a complication is suspected. A study by Bryant, Wiot, and Kloecker (2) showed that, in the adult, body habitus is the most important factor affecting the occurrence and duration of postoperative free air. They pointed out that the time required for disappearance of the residual air depended only on the amount initially trapped and was not influenced by peritonitis, type of surgical procedure, or any other factor except the presence of drains, along which, in rare instances, air entered the peritoneum. The obese patient tended to trap only small amounts of air initially and hence, almost invariably, the abdomen was free of air by the third day. The thin patient, on the other hand, often showed large amounts ...

Cardiac rotation in left lower lobe collapse. "The flat waist sign".

Some cases of left lower lobe collapse show slight right anterior oblique rotation of the heart, manifested by loss of the concavity of the left heart border on a perfectly symmetrical posterior-anterior or anterior-posterior projection. This is a useful differential diagnostic sign, because it is not present when the left lower lobe is compressed secondary to left upper lobe emphysema.

The clinical utility of rib detail films in the evaluation of trauma

The objective of this study was to assess the clinical utility of rib detail films (RDFs) when used in addition to chest radiographs in the evaluation of thoracic trauma. A retrospective review of medical records of all patients who obtained RDFs over a 4-year period was carried out. The study participants included 480 adult trauma patients who received RDFs and chest radiographs. Patients were assessed for the presence or absence of rib fracture(s) on radiographs, clinical management, follow-up, and complications resulting from rib fractures.Fractures were identified in 97 (20%) patients by RDFs. There were 26 (27%) complications due to rib injury, all of which were visualized on chest radiographs but not RDFs. Follow-up demonstrated no delayed complications. Treatment was directed only at complications. Visualization of rib fracture alone does not result in any significant change in treatment or outcome for the patient. Therefore, RDFs for blunt chest trauma have a limited clinical utility.

Gastric-bypass-induced-pneumothorax

Substernal gastric bypass has been recently revived to palliate unresectable esophageal carcinoma. We report an unusual postoperative complication of gastric bypass: recurrent pneumothorax responding to nasogastric tube decompression of a distended thoracic stomach.