Margaret E. Williford

Esophageal tuberculosis: findings on barium swallow and computed tomography.

Esophageal tuberculosis secondary to tuberculous mediastinal lymphadenopathy is a very unusual presentation of adult tuberculosis. We report a patient presenting with fever of unknown origin and dysphagia. Barium swallow demonstrated esophageal displacement, mucosal ulceration and perforation with a fistulous tract into the mediastinum. CT of the mediastinum gave the most complete delineation of the tuberculous mediastinal lymphadenopathy which surrounded and displaced the esophagus. The fistulous tract extending from the esophagus into the nodal mass was also seen on CT.

Emphysematous gastritis secondary to disseminated stronglyloidiasis

Emphysematous gastritis is associated with infectious gastritis produced by gas-forming organisms and with noninfectious gastric necrosis, most often secondary to corrosive ingestion. A new case of infectious emphysematous gastritis is reported secondary to disseminated stronglyoidiasis. This case is unique in that the intramural emphysema developed due to diffuse necrosis of the gastric mucosa caused by the filariform larvae ofStrongyloides stercoralis rather than by infection of the gastric wall with gasforming organisms.

Computed tomographic evaluation of lesions in the thoracic apex

Fifty patients with clinically suspected lesions of the chest apex underwent computed tomography (CT) and plain film (PF) examinations in an attempt to define the underlying etiology as benign or malignant. CT was slightly more sensitive in diagnosing malignancy (90%) compared with PF (77%), with a higher predictive value of a negative test (85% vs. 70%), although the differences were not statistically significant. The specificity and predictive value of a positive test were similar for CT and PF. CTs advantage was better elucidation of the soft tissues of the chest apex. CT provided additional information beyond PF in 17/20 patients with benign conditions and in 29/30 patients with cancer. In 21 of these 29 cancer patients, CT findings significantly altered subsequent management.