Kelvin Fm

Malignant melanoma: Patterns of metastasis to the small bowel, reliability of imaging studies, and clinical relevance

Abstract OBJECTIVES: The aims of this study were to determine the frequency of different patterns of melanoma metastases to small bowel on radiological examination, and to assess the reliability of the most commonly used radiological methods for detecting these lesions. METHODS: The records of cases archived as melanoma metastatic to the small bowel of the Armed Forces Institute of Pathology were reviewed. The clinical information, type of imaging procedure performed, and radiological features were analyzed and compared to the findings at surgery and at autopsy. RESULTS: A total of 32 patients had clinical and surgical data with pathological confirmation. Seven patients had metastasis involving the duodenum, 22 had jejunal involvement, and 11 had ileal involvement. Metastases were categorized as polypoid, cavitary, infiltrating, or exoenteric. The polypoid pattern was seen in 20 patients (63%), six of whom showed multiple polypoid lesions (>10), referred to as polyposis. The “target lesion,” a discrete polypoid mass with a central ulceration, was observed in only three (9%) of the 32 patients. Eight patients (25%) demonstrated a cavitary pattern, a circumferential mass with inner marginal necrosis, and five (16%) showed an infiltrating pattern. One patient (3%) had an exoenteric lesion with a fistulous tract. The small bowel follow-through demonstrated 32 of 55 metastases (sensitivity 58%). Contrast-enhanced CT demonstrated 32 of 48 masses (sensitivity 66%). Of the six cases of malignant polyposis, none were identified using CT, and only two were diagnosed by small bowel follow-through. CONCLUSIONS: The polypoid pattern, equally distributed between the jejunum and ileum, is the most common manifestation of metastatic melanoma to the small bowel. The target lesion was infrequently seen in this series. Small bowel follow-through and conventional CT seem to be unreliable in demonstrating melanoma metastases to the small bowel.

Sonography of appendiceal intussusception

A case in which appendiceal intussusception was diagnosed preoperatively by sonography is described. The sonographic finding of multiple concentric hypoechoic and hyperechoic rings was confirmed at laparotomy to be due to appendiceal intussusception. Demonstration of the sonographic coiled spring sign in the right lower quadrant should raise the possibility of appendiceal intussusception. The differential diagnosis is discussed.

Pelvic magnetic resonance imaging for assessment of the efficacy of the Prolift system for pelvic organ prolapse

OBJECTIVE The purpose of this study was to compare pre- and postoperative pelvic organ prolapse-quantification (POP-Q) and magnetic resonance imaging (MRI) measurements in patients who undergo total Prolift (Ethicon, Inc, Somerville, NJ) colpopexy. STUDY DESIGN Pre- and postoperative MRI and POP-Q examinations were performed on patients with stage 2 or greater prolapse who underwent the Prolift procedure. MRI measurements were taken at maximum descent. Correlations between changes in MRI and POP-Q measurements were determined. RESULTS Ten subjects were enrolled. On MRI, statistically significant changes were seen with cystocele, enterocele, and apex. Statistically significant changes were seen on POP-Q measurements for Aa, Ba, C, Ap, Bp, and GH. Positive correlations were demonstrated between POP-Q and MRI changes. Minimal tissue reaction was seen on MRI. CONCLUSION The Prolift system is effective in the surgical management of pelvic organ prolapse as measured by POP-Q and MRI. Postoperative MRIs support the inert nature of polypropylene mesh.

Barium enema utilization within a defined geographic region: A survey

All 118 hospital-based radiology departments in Indiana (USA) responded to a survey of barium enema (BE) utilization. The percentage of community hospitals in Indiana using barium enema, both single contrast (SCBE) and double contrast (DCBE), for various indications was similar to that reported for major medical centers around the world (RF Thoeni and AR Margulis,Radiology, 167:7–12, 1988). The use of SCBE and DCBE did not differ between small and large hospitals, or between hospitals in small vs large communities. There was, however, wide variation among community hospitals in their overall use of either contrast technique. Barium enema was usually performed without antecedent sigmoidoscopy. However, 60% of Indiana hospitals perform BE on the same day as flexible sigmoidoscopy.The results indicate that the use of BE in community hospitals in Indiana is similar to that reported for major medical centers. Also like major medical centers, there is no consensus regarding many issues in the performance of BE.