Marvin E. Haskin

Pitfalls and unusual findings in computed tomography of the lumbar spine.

A number of interesting and often unusual computed tomographic (CT) abnormalities that were seen in the course of a large series of CT studies of the lumbar spine are presented. These include conjoined nerve roots, extremely gas in the canal, extremely lateralized disk herniations, “vacuum” disks, and Schmorl nodes. In the postoperative patient, extradural hematoma. iatrogenic vacuum disk, and iatrogenic pseudonieningocele can be encountered.

CT diagnosis of broncholithiasis.

Computed tomography clearly demonstrated broncholithiasis rather than suspected malignancy as the cause of segmental atelectasis of the right middle lobe. Possible technical limitations as a source of error are presented.

Role of CT scanning in the superior Vena cava syndrome

The value of computerized tomographic (CT) studies was compared to other imaging procedures in 18 consecutive patients with the superior vena cava syndrome (SVCS) during a 47-month period. Sixteen of these cases had proved malignancy. In addition to tumor masses, CT findings included effacement, compression, and displacement of the great vessels and the presence of thrombi and collateral blood flow. Significantly, tumor was demonstrated in the region of the superior vena cava in five patients in whom a definite mass could not be diagnosed by other means. CT scanning in a sixth case revealed that although mediastinal tumor was present it was not located in the immediate region of the occluded vessels. CT was corroborative and helpful in planning therapy in all but one of the remaining patients. CT scans appear to be of most value in cases of SVCS in whom other modalities cannot demonstrate tumor and, particularly, in excluding recurrent tumor in previously treated patients.

The Hughes-Stovin syndrome. Case report.

A 25-year-old woman was found to have Hughes-Stovin syndrome, previously reported only in males. This rare entity may be suspected when a relatively young patient presents with evidence of thromboembolic pulmonary disease, with one or more enlarging pulmonary masses associated with evidence of systemic venous thrombosis (vena cava, peripheral veins, or dural sinuses). Arteriography will disclose one or more aneurysms of the pulmonary arteries.

Erosion of the sternal ends of the clavicles. A new sign of primary and secondary hyperparathyroidism.

Erosive changes of the sternal ends of the clavicles have been observed in patients with primary or secondary hyperparathyroidism. These changes may or may not be associated with erosions of the acromial ends. Careful scrutiny of the sternoclavicular areas on regular frontal chest films will usually disclose these changes, and their detection may allow a radiographic diagnosis of hyperparathyroidism from an otherwise negative chest study. Advanced rheumatoid arthritis can also produce similar erosive changes.

Experimental Studies with a New Radiopaque Emulsion

A long and generally unsuccessful search has been made for a safe radiopaque colloid or emulsion to be employed in intravenous hepatosplenography. We should like to report our recent experiences in the development and experimental use of such an agent, as well as its apparent benefit in a number of other fields of contrast radiography. The most widely used colloid has been Thorotrast, a 25 per cent colloidal suspension of thorium dioxide. Although it produces a satisfactory opacification of the liver and spleen, it has been almost completely abandoned because it is radioactive and has been shown to produce malignant tumors secondary to its permanent deposition and long half-life, at least 50 such cases having been reported (1, 2, 3). Preparations of nonradioactive, insoluble, heavy-metal salts such as barium sulfate (4), zinc, and tantalum oxide (5) have been prepared and tested. These have been suspensions rather then true colloids and, because of their subsequent instability and large particle size, hav...

Total myelography with radiopaque emulsions.

Myelography continues to be the basic and essential procedure for the diagnosis of abnormalities of the spinal cord and canal. The shortcomings of the procedure as currently performed are due, in large measure, to the inadequacies of the contrast media. Our experimental studies with various radiopaque emulsions are the subject of this report. Air was the original contrast medium, introduced by Dandy (1) in 1919. Air myelography does not require fluoroscopic manipulation and the air is completely absorbed. However, a large number of inconclusive examinations due to the relatively poor contrast qualities of air and the high percentage of complicating severe headaches have severely limited its use. Positive contrast myelography with iodized oil (Lipiodol) was introduced in 1922 by Sicard and Forestier (2). Although visualization was satisfactory, the medium was too dense, tended to break up into droplets, and was extremely difficult to remove from the spinal canal. Chronic meningeal irritation frequently res...

Urographic and angiographic changes in acute unilateral pyelonephritis

The pyelographic and angiographic changes in acute unilateral bacterial pyelonephritis are illustrated in our series of 12 patients. The radiographic abnormalities were completely reversible within a few weeks after clinical recovery. Complications (abscess) occurred in only one patient. Unilateral renal enlargement, diffuse or focal, impaired or absent excretory function, and attenuated calyces were the predominant findings; non-obstructive pelvicalyceal and/or ureteral dilatation were infrequent. Angiographic studies (fivepatients), performed to rule out vascular occlusion, tumour or carbuncle, showed attenuated and somewhat stretched intrarenal vessels associated with the diffuse or focal cortical swelling. Occasionally, a characteristic striated nephrogram is seen.

CEREBRAL HEMANGIOENDOTHELIOMA SIMULATING A BERRY ANEURYSM.

Cerebral angiography is a reliable and accurate method for diagnosing intra-cerebral aneurysms (1, 2). Arteriovenous malformations, both congenital and acquired, and berry aneurysms have rather characteristic angiographic appearances and are rarely confused with one another. Although there is a definite incidence of false negative arteriographic studies with berry aneurysms (3, 5), the occurrence of a false positive is rare. The following case is of interest because, to our knowledge, it is the first to be reported of an acquired form of a cerebral arteriovenous malformation closely simulating a peripherally located berry aneurysm on angiographic study. Case Report A 31-year-old chronic alcoholic was admitted to the Philadelphia General Hospital because of gradually increasing right-sided abdominal pain, cough, and hemoptysis. During the week prior to admission, he had suffered from anorexia, nausea, and weakness. The patient had been taking diphenylhydantoin (Dilantin) for about two years intermittently ...

Computerized Interactive Diagnostic Intelligence Center

Information and images from multiple sources, including CT, Ultrasound, and Angiography are transmitted to a central processing center. The digital information has standardized formats allowing for data manipulation and image processing. Display is either in single or multi-image format and integration of patient information is by multiformat cameras. Initial experience using this system will be presented.