Mahesh Kinkhabwala

Arteriovenous shunts involving the liver.

Arteriovenous shunting in the liver is a rare angiographic finding. Review of the literature shows that most cases are related to trauma or neoplasm. The authors discuss several entities which should also be included in the differential diagnosis, among them congenital arteriovenous malformations or hemangiomas of the liver and pancreas, cirrhosis with rearterialization of the liver, hepatic abscess, hypervascular liver metastases, and primary tumors with invasion of the portal and hepatic veins by arterial neovasculature.

Renal pelvic carcinoma. An angiographic re-evaluation.

A series of 22 cases of renal pelvic carcinoma were reviewed in an attempt to find characteristics which would distinguish this entity from hypernephroma which it closely resembles. Distinctive angiographic characteristics are enlarged pelviureteric artery, fine neovascularity, vascular encasement, and absence of arteriovenous shunting. Since ureteronephrectomy is the preferred treatment for renal pelvic carcinoma, the importance of differentiating this tumor from other renal lesions is strongly stressed.

Giant aneurysm of the splenic artery

Abstract Two giant aneurysms (15 and 18 cm) of the splenic artery are reported. One patient demonstrated radiographic findings of a chronic process and an underlying cause of medial hyperplasia.* The second patient demonstrated the clinical and radiographic findings of an acute aneurysm with rupture.

Hemangiomas of the liver in patients with renal cell carcinoma.

Five patients with renal cell carcinoma were noted at angiography to have vascular hepatic lesions which resembled metastatic renal cell carcinoma but which proved to be benign hepatic hemangiomas. The angiographic differentiation between small hemangiomas and metastatic vascular neoplasms of the liver can be difficult; angiographic characteristics may not be definitive. Surgery to remove the renal tumor should not be deferred solely on the basis of vascular hepatic lesions found at angiography.

Osler-Weber-Rendu syndrome with multiple angiographic findings

Hereditary haemorrhagic telangiectasia or the Osler-Weber-Rendu syndrome is a hereditary disease manifested by telangiectasia of the skin and mucous membranes resulting in repeated episodes of epistaxis. The angiographic findings have been mainly oriented towards the arteriovenous malformations found in the lung and brain (Alexander and Harrington, 1955; Burchell and Claggett, 1947). The syndrome is basically a generalized vascular dysplasia, and other vascular changes, particularly in the abdomen, may be encountered (Hodgson et al., 1959). The latter features have been infrequently mentioned in the medical literature. This case report illustrates the various vascular changes found in this syndrome and emphasizes those found at abdominal angiography.

Acute emphysematous gastritis. The significance of the angiographic findings.

A case of acute emphysematous gastritis secondary to severe hemorrhagic inflammation is presented. An arteriogram obtained during the acute stage revealed vascular changes that were distinct from those associated with gastric carcinoma. It is conceivable that these criteria will enable differentiation of inflammatory disease from carcinoma in cases in which the diagnosis remains in doubt.

Urography in Renal Failure: Acid-Base Balance

Acid-base studies in patients in renal failure after the slow injection of contrast material have again demonstrated the safety of urography. A serum osmolality elevation averaging 2.2% occurred after injection and tended to return toward a baseline level within one to two hours after injection. This is considered to be an insignificant alteration. None of the other parameters measured showed changes. No evidence of a difference in the relative value of sodium or methylglucamine salts was found.

“Intersplanchnic steal syndrome”: another cause for reversible distal colon ischaemia

Ischaemic disease of the colon is generally attributed to small vessel disease. Not infrequently, however, lesions of the inferior mesenteric artery are identified causing insufficiency either by thrombotic or embolic occlusion of the vessel, or by low perfusion associated with shock, massive haemorrhage, etc. (Byrd et al., 1968; Farman, Betancourt and Kilpatrick, 1968; Schwartz et al., 1963). We have recently encountered another cause of inferior mesenteric artery insufficiency, namely an “intersplanchnic steal” phenomenon. Arteriographic studies demonstrated severe stenosis of the superior mesenteric artery. The flow of blood in this situation was diverted from the inferior mesenteric artery to supply the superior mesenteric vessel resulting in ischaemic disease of the distal colon. This collateral pathway is a well-known route of support to areas of decreased perfusion within the splanchnic bed. A search of the literature has revealed no case in which this abnormal flow pattern has resulted in ischaemi...

Abdominal Angiography: Acid-Base Balance

Abstract Following rapid injection of contrast material, acid-base studies in patients with normal and impaired renal function showed only minimal changes. Alterations in serum osmolality and hematocrit levels were seen but deemed insignificant.