John H. Stanley

Evaluation of biliary cystadenoma and cystadenocarcinoma

Biliary cystadenomas and cystadenocarcinomas are among the rare neoplasms of the biliary ductal system. This article presents 3 adult patients in whom such large multiloculated biliary tumors were diagnosed. The characteristic features noted on ultrasonography, computed tomography, and angiography of the liver are illustrated and the literature is reviewed.

Quantitative analysis of the cervical spinal canal by computed tomography

SummaryComputed tomography measurements of the AP diameter, width, and cross-sectional area of the bony cervical canal were derived from cervical spine examinations of fifty-two normal adults. These quantitative parameters were then used to evaluate 80 patients with various cervical abnormalities to determine the clinical usefulness of the measurements. With the exception of spinal stenosis, quantitative cervical canal analysis was found to be of limited usefulness since normal measurements frequently occurred in the presence of significant cervical pathology.

Periportal tuberculous adenitis: a rare cause of obstructive jaundice.

A patient with a clinical history of pulmonary tuberculosis presented with obstructive jaundice. Compression of the extrahepatic bile ducts was caused by calcified lymph nodes secondary to tuberculous adenitis of the porta hepatis. The role of radiologic methods in the diagnosis and management of this unusual complication is discussed.

The Effect of Drainage Tube Size on Adequacy of Percutaneous Abscess Drainage

Fifty-one patients with documented abdominal abscess cavities were treated by percutaneous abscess and fluid drainage (PAFD). Drainage catheters made of various materials in sizes ranging from 5 through 18 French (Fr) were retrospectively studied and prospectively assigned to patients. No significant difference in the success or failure of PAFD as a function of these factors was found once an 8.3 Fr catheter with 0.045-inch diameter sideholes was reached; catheters larger than this were not associated with improved patient outcome. Failues of PAFD occurred primarily with the presence of phlegmonouscollections and cavities with fistulous connection to bowel.

Treatment of acute embolus of the superior mesenteric artery by topical infusion of streptokinase

Two patients with sudden onset of acute abdominal pain caused by embolic disease of the superior mesenteric artery (SMA) were evaluated angiographically. In one patient, the study was performed soon after the clinical onset of symptoms, and successful treatment with low-dose topical streptokinase infusion produced total lysis of the clot over a period of 30 h. In the second patient, the angiogram was obtained 6 days following the initial episode of pain. Radiographic and clinical findings indicated advanced gastrointestinal ischemia with bleeding which contraindicated the use of fibrinolytic therapy. Surgical resection of infarcted intestine was required. Early angiographic detection of acute mesenteric thrombus or embolus is crucial for the selection of patients for fibrinolytic therapy. Our cases suggest that with early diagnosis, streptokinase infusion is an alternative to surgical management of selected patients with acute mesenteric ischemia.

Percutaneous drainage of pancreatic and peripancreatic fluid collections

Radiographically guided therapeutic percutaneous catheter drainage was used to manage 25 patients with 27 pancreatic and peripancreatic fluid collections. Nine of 11 (82%) noninfected and 11 of 16 (69%) infected collections were successfully managed with percutaneous drainage. Overall, eight complications and four deaths occurred in this group of patients. The morbidity and mortality in this series is somewhat higher than that previously reported in the radiologic literature. A discussion of the guidelines for percutaneous drainage is presented.

Embolic management of rare hemorrhagic gynecologic and obstetrical conditions

Severe life-threatening hemorrhage was controlled by angiographic management in 3 patients with bleeding due to unusual gynecological abnormalities and in 1 patient with a rare obstetrically related hemorrhage. Successful management of such rare causes of bleeding emphasizes that early angiographic intervention can, in selected patients, reduce the need for an immediate or subsequent surgical procedure and allow conservative management followed by disease-specific therapy.

Vertebral vacuum phenomenon - A radiographic manifestation of metastatic malignancy

Gas lucency within intervertebral disc spaces, the vertebral vacuum phenomenon (VVP) was visible radiographically in 12/42 (28%) women with adenocarcinoma of the breast metastatic to bone. In 7/12 (17%) the VVP occurred adjacent to vertebra involved with metastatic tumor and free of significant degenerative changes. Vertebral collapse occurred in all seven women, but was minimal in some when the VVP was prominent. Metastatic malignancy should be considered along with degenerative disease when the VVP is observed.

Angiographic demonstration of gastrointestinal neurofibromas in von Recklinghausen's disease

Two cases of intestinal neurofibromas which were demonstrated during mesenteric arteriography are described. In 1 patient, tumors located in the jejunum and distal ileum were the apparent source of gastrointestinal bleeding. In another case, a neurofibroma of the proximal jejunum was an incidental finding during evaluation for severe pancreatitis and bleeding from esophageal varices.

Pancreaticopleural fistula: demonstration by computed tomography and endoscopic retrograde cholangiopancreatography

Pancreaticopleural fistula is an uncommon complication of chronic pancreatitis or pancreatic trauma. Clinical features include pleural effusion and resulting pulmonary symptoms. Abdominal pain and other clinical manifestations of pancreatitis may be minimal or absent. As in this case, computed tomography and endoscopic retrograde cholangiopancreatography may provide complementary diagnostic information in the evaluation of this condition. A discussion of the pathophysiology, diagnosis, and management of pancreaticopleural fistula is presented.