Leon Love

Neonatal ascites associated with urinary outlet obstruction (urine ascites).

Severe abdominal distention at birth is usually a serious life-threatening condition. When diagnosed in the uterine cavity before delivery the problem of soft-tissue dystocia arises (8). The etiology of an enlarged fetal abdomen in the third trimester of gestational development is usually one of the following conditions: enterogenous tumor, teratoma, polycystic kidney, neuroblastoma, Wilmss tumor, polycystic disease or large neoplasm of the liver, hydrometrocolpos, ovarian tumor, generalized edema from hemolytic disease or maternal diabetes, absence of abdominal muscles, massive hydronephrosis, or ascites (7). Ascites is the rarest etiology of a distended abdomen in the neonatal period. It is interesting to note that approximately 200 ml of fluid must be present in the peritoneal cavity before ascites becomes evident clinically. As early as 1894 Fordyce (2) published a review of fetal and neonatal ascites. Among 63 cases he collected from the literature, 17 had urinary tract abnormalities accompanied by ...

Computed tomography staging of renal carcinoma.

The ability of fast third-and fourth-generation scanning devices to supply images of sufficient quality to delineate the kidney, its vascular supply, and surrounding fascial envelope has provided a modality which permits preoperative staging of tumors of the kidney with an accuracy of about 90% in limited series of 20 specimen cases. The unreliability of bolus injection to evaluate tumor extension to the renal vein accounted for two errors.

DIAGNOSIS OF DISSECTING AORTIC ANEURYSM BY COMPUTED TOMOGRAPHY

Computed tomography (CT) of the torso combined with simultaneous intravenous bolus injection of contrast media was used in sixteen patients suspected of having dissected their aorta. All patients had subsequent correlative percutaneous aortography within 24 h of the CT examination. Four patients proved to be normal, one had an aneurysm of the thoracic aorta, and eleven had aortic dissection (five type I, six type III dissection). All eleven patients with aortic dissections were diagnosed by CT and angiography; nine had spontaneous dissections and two had iatrogenic injuries to the aorta. Limitations of this imaging procedure include; inability to detect aortic valvular dysfunction and failure to provide an adequate perspective of aortic branch involvement. Potential benefits include: avoidance of aortogram in some cases, relative non-invasiveness, rapidity and ease of procedure, and less expense, radiation, contrast media, and discomfort to the patient. Early experience with CT-enhancement technique has reliably demonstrated normal as well as abnormal aortic wall morphology. It may have a place as an alternative to the conventional aortogram.

Hemorrhagic Adrenal Metastases: CT Findings

Adrenal hemorrhage secondary to metastases is uncommon. We have encountered four such cases that presented as large adrenal masses. In all cases the CT findings were of an inhomogeneous mixed-density adrenal mass with extensive perirenal changes suggestive of perirenal hemorrhage or mass. When such a lesion is seen, hemorrhagic adrenal metastases should be considered. Fluid may be of high density, suggestive of hemorrhage. However, as the adrenal is in the perinephric space, hemorrhage from any cause (trauma, metastases, or anticoagulant) in the adrenal gland will gravitate into the perinephric space.

CT diagnosis of idiopathic aneurysms of the thoracic systemic veins.

Three patients with idiopathic aneurysms of the superior vena cava, left innominate vein, and inferior vena cava are presented. The advantages of CT over other diagnostic modalities are discussed.

Trauma to the esophagus.

We have classified. esophageal trauma into three major categories: (1) Iatrogenic trauma including endoscopic perforation, trauma due to dilatation, surgical trauma, tube trauma, radiation trauma, and drug trauma; (2) Self-induced trauma including foreign bodies, corrosive or drug ingestion, and postemetic trauma; (3) Direct trauma including penetrating trauma and blunt trauma. Discussion and illustrative cases are presented.

The angiographic patterns of the primary retroperitoneal tumors. The role of the lumbar arteries.

Abstract The lumbar and inferior intercostal arterial systems provide a major arterial supply of the retroperitoneal area, and abnormalities in their configuration, position, distribution, and size may indicate whether a mass is retroor intraperitoneal. In some instances, the histological nature of the mass may be predicted by the characteristics of its blood supply. Aortography with subsequent selective angiography to evaluate the feeding vessels and their branches is of value in the diagnosis of retroperitoneal masses.

Normal excretory urography in patients with primary kidney neoplasms

The records of 65 consecutive patients discharged from the hospital with a diagnosis of primary parenchymal neoplasm of the kidney were reviewed. Four of the 65 patients had neoplasms which were not detected by excretory urography. The 4 undetected lesions included 3 renal cell carcinomas and 1 oncocytoma. All of these lesions projected from the anterior or posterior surface of the kidney, and all 4 were clearly demonstrated by computed tomography. Normal findings on an excretory urogram do not completely exclude a neoplasm of the kidney. When there is strong clinical suspicion of a renal neoplasm, computed tomography should be the initial examination or should be done even if the urogram has shown normal findings.

Arteriography of splenic trauma.

The most frequently injured organ in cases of blunt abdominal trauma is the spleen (10). Numerous reports have dealt with attempted roentgen diagnosis of splenic trauma on routine abdominal films (4, 8, 11, 13). More recently arteriography has been utilized in an effort to effect a greater accuracy in diagnosing this condition. Of historical interest is Burke and Madigans 1933 report (3) of the diagnosis of a ruptured spleen with Thorotrast. The first case in which arteriography via a retrograde femoral route was used was diagnosed by Norell (6). Various other methods, such as selective celiac or splenic arteriography and intravenous aortography, have added only 5 other cases to the English literature (2, 5, 7, 9). At a large trauma center we have had the opportunity to evaluate a number of suspect splenic injury patients and have made the correct preoperative diagnosis with arteriography in 17 instances of splenic rupture. Our purpose is to present the arteriographie findings in these cases and discuss ...

Infusion Tomography of the Gallbladder

The wall of an acutely obstructed gallbladder can be demonstrated by total-body opacification. In most instances, this technique will demonstrate a sharply or poorly defined wall 2–8 mm thick outlining the distended gallbladder, thus confirming the diagnosis of obstructive cholecystopathy. This technique eliminates uncertainty in the differential diagnosis of acute gallbladder disease caused by nonvisualization of the gallbladder on oral cholecystography or intravenous cholangiography.