Michael C. Beachley

Evaluation of Retroperitoneal Hemorrhage by Computed Tomography Before and After Translumbar Aortography

Twenty patients were prospectively studied by computed tomography (CT) before and after undergoing translumbar aortography (TLA). Changes indicative of retroperitoneal bleeding were depicted by CT in all 20 patients despite the predominantly small size of the hematomas. CT scans obtained within two hours after TLA demonstrated: (a) thickening of the diaphragmatic crura, (b) enlargement of the left psoas muscle, and (c) obscuration of the aortic outline by soft-tissue density. Follow-up scans at 24 hours (10 patients) and one week (3 patients) revealed marked decrease in abnormalities, suggesting rapid resorption of the hematoma.

Aneurysm of a persistent sciatic artery

Angiographic examination in a patient with sciatic-like pain on the right side and a firm, pulsatile, non-tender mass in the right buttock revealed a large sciatic artery aneurysm. The aneurysm was successfully resected at surgery.The primitive sciatic artery is the main arterial supply to the lower extremities in the 9-mm embryo. Its persistence, while very rare, is of clinical significance because of the tendency for aneurysms to develop in the artery. Surgical resection is indicated in sciatic artery aneurysms because of the danger of rupture or embolic occlusion of arteries distal to the aneurysm.

Fibrodysplasia of the Popliteal Arteries

Fibrodysplasia is a generalized arterial dysplasia of unknown etiology. We report a case involving both popliteal arteries. The patient presented with microemboli of the toes of both feet originating in the dysplastic popliteal arteries. The clinical significance of popliteal artery fibrodysplasia is briefly discussed.

Computed tomography versus angiography in the localization of pheochromocytoma.

We report eight patients studied by computed tomography (CT) and arteriography and one patient studied by CT only and compare the value of both methods in the preoperative localization of pheochromocytoma. Single adrenal tumors were found in six adults (four were right sided and two were left sided). A 15-year-old child had bilateral adrenal tumors, and a 12-year-old child had a left adrenal tumor. An extraadrenal pheochromocytoma was found in another adult patient. Computed tomography demonstrated all but one tumor (a right adrenal lesion measuring 2.5 cm in the child with bilateral pheo-chromocytomas, both well shown by angiography). Arteriography, including subtraction films, demonstrated all but one tumor (an avascular extraadrenal pheochromocytoma measuring 4 x 8 cm well shown by CT). We believe that both CT and angiography contribute significant information in the preoperative evaluation of patients suspected of harboring a pheochromocytoma.

Inflamed duodenal diverticulum. Preoperative radiographic diagnosis.

SummaryThe sixth reported case of duodenal diverticulitis diagnosed preoperatively is presented. A review of the literature indicates that most duodenal diverticula are asymptomatic and require little special management. Rarely, acute inflammation can develop, and duodenal diverticulitis must be included in the differential diagnosis of all acute upper abdominal conditions, especially in the radiographic differential of emphysematous cholecystitis and retroperitoneal emphysema.

Selective low-dose streptokinase infusion in the treatment of acute transplant renal vein thrombosis.

A renal transplant recipient developed acute renal transplant vein thrombosis following surgery for a total hip replacement. As an alternative to standard surgical therapy, the patient was treated with selective intravenous low-dose infusion of streptokinase at doses of 5,000–20,000 units/h. The infusion was continued for 120 h with constant monitoring of PT, PTT, and fibrinogen levels. Therapy resulted in excellent preservation of renal function without complications. Low-dose selective infusion of streptokinase should be considered a potential alternative therapy for acute transplant renal vein thrombosis.

Radiographic findings in the chest of patients following cardiac transplantation

The postoperative chest radiographic findings in 38 patients undergoing orthotopic (37 patients) and heterotopic (1 patient) cardiac transplantation were evaluated. Findings were correlated with those of echocardiograms, sputum and blood cultures, and lung and heart biopsies. The radiographic manifestations in the chest of these patients are classified in the following three main categories: (1) Newly formed cardiac silhouette findings due to the transplanted heart itself, i.e., changes in size and shape of the new heart and pericardial effusion resulting from the placement of a smaller heart in a larger pericardial sac. (2) Infectious complications due to bacteria, fungal, and other opportunistic agents secondary to immunosuppressive therapy, and (3) Usual postoperative complications following thoracotomy and open-heart surgery.

Combined radiographic and ultrasonographic approach in diagnosis of renal inflammatory lesions.

Seven cases of inflammatory lesions of the kidneys are reported. In 6 of the 7 patients, there were clinical and/or laboratory signs of urinary tract infection. The lesions occurred without any preference to age, sex, or location as to the right or left kidney. The diagnostic approach was individualized, and a correct preoperative diagnosis was made in 6 of the 7 cases. This high diagnostic accuracy was reached by using the following diagnostic principles. The lesions are detected and localized by urography and nephrotomography. Ultrasonography is used to decide whether the mass is solid or cystic. A percutaneous needle puncture is done in cases in which ultrasonography indicates a cystic lesion. The diagnosis of renal cyst is confirmed or excluded by cytology and analysis of the cyst fluid. Renal angiography is performed when the mass displays a solid or mixed ultrasonographic pattern and also in cases of hematuria and in cases in which the clinical symptomatology suggests malignancy.

Computed tomography versus angiography in the diagnosis of large right adrenal carcinomas

Adrenal carcinomas are rare. We present four surgically and pathologically proved large right adrenal carcinomas studied by computed tomography, angiography, and other imaging modalities. Computed tomography demonstrated large nonhomogeneous right upper quadrant masses in all four cases, but the adrenal origin of the mass could not be ascertained by computed tomography in three patients due to the transverse display of the anatomy. Ultrasonography provided important additional information in these cases. Arteriography was diagnostic in each case by demonstrating minimal to marked tumor vascularity supplied by adrenal arteries. We also present, for differential diagnostic purposes, a proved benign adrenal hemorrhagic cyst with computed tomography and angiography findings indistinguishable from those of adrenal carcinomas. Computed tomography does not eliminate the need for angiography in patients with large right upper quadrant masses suspected of being an adrenal carcinoma.

Angiographic Diagnosis of a Bleeding Jejunal Diverticulum

The authors report on the preoperative diagnosis of a bleeding jejunal diverticulum by selective arteriography. The angiographic findings, as well as the difficulties of the intraoperative localization of bleeding jejunal diverticula, are discussed.