Joseph P. Whalen

Radiologic features of extraperitoneal effusions. An anatomic approach.

Abstract Criteria for radiological diagnosis of specific compartmentalization of extraperitoneal fluid and its possible sources were developed by (a) determining pathways of extraperitoneal fluid flow and establishing preferential routes of spread from various sites; (b) establishing fascial boundaries which direct and compartmentalize extraperitoneal fluid collections; and (c) defining the role of peritoneal reflections in the passage of exudates. The correlation of the distribution of fluid with the extraperitoneal fascial planes is based on cross-sectional planes derived from frozen cadavers, postmortem injection studies, and selected clinical cases in various disease states.

The Nonopacified Gallbladder on Oral Cholecystography

A retrospective review of 5,000 patients studied over a period of three years showed that a second dose was necessary in 25% of gallbladder examinations; however, third and fourth doses gave no additional information. Nonopacification of the gallbladder after a second examination is diagnostic of disease when all extrinsic factors have been ruled out. Intravenous cholangiography may show calculi in a diseased gallbladder that was not opacified on the oral study, since it does not depend on the concentrating ability of the gallbladder for opacification; however, a radiographically normal gallbladder on intravenous cholangiography does not rule out nonobstructive cholecystitis or cholelithiasis.

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.

Classification of perihepatic abscesses.

The purpose of this paper is twofold: (a) to definitely establish the anatomy of the perihepatic spaces and correct the existing errors in both the surgical and the radiographic literature; and (b) to establish and demonstrate a classification which is practical anatomically and radio-logically. Much of the confusion concerning perihepatic abscesses exists because of dissections which distort the anatomic relationship after the abdomen is opened or because of impressions gained by key-hole incision for drainage. As is usual, the simplest approach becomes the most useful and accurate. A knowledge of the border-forming ligamentous attachments of the liver should give definition to all the multiple potential spaces around it and become the key to their localization. For a conceptual radiologic approach the most accurate localization appeared to be achieved by means of sagittal-section anatomy. For this purpose we used dry ice to freeze cadavers and with a band saw sliced multiple sagittal sections of the liv...

Computed tomography versus magnetic resonance imaging of the brain a collaborative interinstitutional study

A retrospective study (1983-1984) of magnetic resonance imaging (MRI) and computed tomography (CT) examinations in 471 patients with known pathology in the brain and craniocervical junction was conducted in order to determine the relative efficacy of MRI versus CT. All MRI examinations involved slice thickness greater than 10 mm, and only single-slice single-echo or multislice single-echo imaging techniques were available. These studies were evaluated independently by two neuroradiologists from a panel of six for anatomic abnormalities, lesion contrast, and radiologists impression. Results, which excluded microadenomas of the pituitary and approximately 9% of studies in which consensus was not achieved by the readers, were as follows: (1) 14% of the studies were positive on MRI but normal on CT; (2) in 55% of the studies, MRI was better than CT; (3) MRI was equal or better than CT in 95% of the studies; and (4) CT was better than MRI in 5% (21/421) of the examinations. There were no patients in this series where CT was positive but MRI missed the abnormality.

The Extraperitoneal Perivisceral Fat Pad: II. Roentgen Interpretation of Pathological Alterations

THE PURPOSE of this paper is to describe the roentgen manifestations of alterations of the normal anatomy of the extraperitoneal perivisceral fat pad and to emphasize that both intra- and extraperitoneal pathologic processes can affect the e. p. f. p. Intraperitoneal Disease A. Fluid: Intraperitoneal fluid in the upper abdomen frequently manifests itself radiologically by collecting adjacent to the properitoneal fat line as a linear density, displacing the colon medially and thinning the properitoneal fat. This shadow has been called the “flank stripe” (5). In addition, the medial margin of the “hepatic angle” may be lost (Fig. 1). What is the explanation for the loss of the hepatic angle by intraperitoneal fluid if the shadow of the hepatic angle is cast by the livers contrasting with extraperitoneal Iat?3 The great pliability of the e. p. f. p. explains this finding. The intraperitoneal fluid fills the peritoneal recess about the posterior inferior portions of the liver, widening and blunting it. The f...

Time of Optimal Gallbladder Opacification with Telepaque (Iopanoic Acid)1

The time to peak visualization of the gallbladder was recorded in a series of 47 patients Previously, fourteen hours had been given as the time of maximum opacification after ingestion of Telepaque. A range of fourteen to nineteen hours was demonstrated as giving peak opacity in this series. These findings allow greater latitude in the arrival of patients in the x-ray department.

Nutritional secondary hyperparathyroidism in the animal kingdom: report of two cases

This report describes two cases of marked bone loss (osteopenia) occurring in a 9-week-old German shepherd puppy and in a 6-month-old tiger. In both cases the animals were fed a diet which was exclusively boneless meat. The diets in both cases contained approximately 40 mg of calcium and 1000 mg of phosphorus per pound resulting in both calcium deficiency and phosphorus excess, resulting in a phosphorus-to-calcium ratio of 25:1, well beyond the amounts known to cause marked loss of bone experimentally. This has been termed nutritional secondary hyperparathyroidism (NSH). Both animals presented with severe bone pain, difficulty in ambulation, and difficulty in chewing food. Radiographs showed marked osteopenia and spontaneous fractures. Both responded clinically and radiographically to calcium supplementation and a diet with an appropriate phosphorus-to-calcium ratio. The importance of calcium and phosphorus in the human diet is briefly discussed.

Evaluation of competing tests for the diagnosis of pulmonary embolism and deep vein thrombosis, Part I.

Tests for pulmonary embolism (PE) and its most frequent source, deep vein thrombosis (DVT), include angiography, ventilation-perfusion nuclear medicine scans, venous sonography with Doppler, and contrast and radionuclide leg venography. Although selective angiography is the definitive procedure for the diagnosis of PE, the associated risk of death, although small, as well as the morbidity associated with injection of contrast agents, are high enough that alternative, less accurate, but safer diagnostic procedures are performed in an attempt to avoid the higher-risk procedure. Effective cost (EC) of each test represents the dollars spent per unit of diagnostic information and is defined as the ratio of the expected direct cost (EDC) of the test to its diagnostic performance (DU). EDC includes the base cost or charge of the test and the estimated cost of the morbidity and mortality that can be incurred in performing the test, while DU is determined from the test sensitivity and specificity. With the lowest EC as the selection criterion for the best test and representative costs, sensitivity, specificity, and morbidity and mortality rates, five different tests for PE or DVT were compared. Doppler sonography yielded the most diagnostic information per dollar spent, as its EC was the lowest, primarily because its base cost was low compared to that of the other tests. Radionuclide leg venography had the second lowest EC. Selection among the remaining three tests depended on the prevalence of PE and morbidity and mortality costs.(ABSTRACT TRUNCATED AT 250 WORDS)

Body computed tomography: A clinically important and efficacious radiologic procedure

In the institutions represented by the authors, more than 7,500 body CT examinations have been performed. Body CT has been found to be particularly useful in solving specific problems, especially when other diagnostic procedures yield confusiing results. Radiologists and their collegues, and not governmental agencies and insurance companies, should define the experimental, research and clinical usefulness of computed tomography.