Michael Oliphant

Inflammatory myofibroblastic tumor in children

The authors presented the cases of two children with inflammatory myofibroblastic (IMF) tumor and reviewed the literature to facilitate the preoperative recognition, delineate the clinical features, and describe the natural history of this entity. The first child had IMF tumor arising from the mesentery of the small intestine. He presented with an abdominal mass associated with severe inflammatory response manifested by fever, impaired growth, thrombocytosis, and microcytic, hypochromic anemia. After surgical resection, his fever resolved and his growth rate and the laboratory abnormalities normalized. Five months after initial diagnosis, the fever, anemia, and thrombocytosis recurred along with two tumors arising from the omentum and the abdominal soft tissue. After the second surgery, he remains free of recurrent disease for 30 months. The second child presented with a lung mass that was radiologically indistinguishable from pulmonary sequestration. After surgical resection, she remains free of recurrent disease for 18 months.

Grey Turner's sign and Cullen's sign in acute pancreatitis

Four patients with acute pancreatitis presenting with Grey Turners sign or Cullens sign have been studied by computed tomography (CT). These observations help confirm the precise anatomic pathways by which the extravasated pancreatic enzymes and their effects lead to these cutaneous discolorations.Grey Turners sign is produced by spread from the anterior pararenal space to between the two leaves of the posterior renal fascia and subsequently to the lateral edge of the quadratus lumborum muscle. Communication may be established to the posterior pararenal space and to the structures of the flank wall. The lumbar triangle, a site of anatomic weakness on the flank wall, may serve as a structural predisposition.Cullens sign can be seen to be secondary to the tracking of liberated pancreatic enzymes to the anterior abdominal wall from the inflamed gastrohepatic ligament and across the falciform ligament. Another more direct pathway may be extension from inflammatory changes of the small mesentery or greater omentum to the round ligament, and then to properitoneal fat deep to the umbilicus.

Ascending retrocecal appendicitis.

Acute inflammation of an ascending retrocecal appendix with abscess formation produces distinctive roentgen signs characterized by irregular nodularity (often restricted to a specific haustral row) and spastic inflammatory changes, which may involve the posterolateral wall of the ascending colon anywhere along its length from the cecum to the hepatic flexure. Even if the appendix cannot be seen, its position may be inferred from the location of the ileocecal valve. Barium opacification of the appendix does not exclude the diagnosis of acute appendicitis. The appendix may demonstrate mass displacement, sinus tracts, or communication with the abscess cavity.

Hemophilia-like arthropathy of the knee associated with cutaneous and synovial hemangiomas. Report of 3 cases and review of the literature.

Three patients with cutaneous and/or synovial hemangiomas demonstrated roentgenographic alterations in the knees, simulating hemophilic arthropathy. In 2 cases, unilateral synovial hemangiomas appeared to be present; in the third patient, who had bilateral abnormalities, the Kasabach-Merritt syndrome was evident, resulting in a consumption coagulopathy and hemorrhagic tendency. The pathogenesis of this unusual arthropathy is discussed.

Spread of disease via the subperitoneal space: the small bowel mesentery.

The designation of the subperitoneal space emphasizes the continuum of the potential space of extraperitoneal and intraperitoneal areolar tissue traversed by blood vessels, lymphatics, and nerves. Across its root, the subserous connective tissue of the small bowel mesentery is anatomically continuous with that deep to the posterior parietal peritoneum. There is thereby provided an avenue of spread from multiple sites to and from the small bowel mesentery and its relationships. These include perforated lesions of the bowel, pancreatitis, lymphoma, neuroblastoma, leiomyosarcoma of small bowel, and hemorrhage of retroperitoneal and pelvic origin.

Direct spread of subperitoneal disease into solid organs: radiologic diagnosis

The subperitoneal space is the continuous space interconnecting the peritoneum and retroperitoneum and the abdominal organs. This report expands the concept of direct spread of disease via the subperitoneal space to include direct extension into the solid abdominal viscera (i.e., liver, kidneys, and spleen). Discussion of the anatomy, case presentations, and imaging with computed tomography, ultrasound, and magnetic resonance are presented. This unifying concept provides an understanding for direct spread of disease presenting clinically or being imaged within a solid abdominal organ.

The cervicothoracic continuum.

The anatomic communications between the neck and the mediastinum are described. Anatomic sections and drawing are used to demonstrate the normal compartments, their fascial envelopes, their contained structures, and their interrelationships. Selected cases are used to illustrate the spread of pathologic processes within the cervicothoracic region.

Bidirectional spread of disease via the subperitoneal space: The lower abdomen and left pelvis

In early fetal life a persistent interconnection between the peritoneum and retroperitoneum of the abdomen and pelvis is formed-the subperitoneal space (SS). This paper serves to complete the description of the specific anatomical nuances of the SS as they relate to the bidirectional direct spread of disease in the left lower abdomen and pelvis. Described are the two avenues of communication (central and lateral pathways) within this portion of the SS. Selected cases illustrating the bidirectional spread of disease processes within this portion of the SS are reported.

A spectrum of renal tubular ectasia and hepatic fibrosis.

Renal tubular cystic disease and hepatic fibrosis exhibit a specific genetic pattern and pathological findings. The renal collecting tubules are dilated and the liver shows fibrosis with proliferation and dilatation of the bile ducts. The findings fall into a spectrum with marked renal disease and mild liver involvement at one end and mild renal involvement with severe liver disease at the other. Between these extremes lies an intermediate form which is genetically and pathologically similar, but exhibits a wide range of clinical and radiological findings due to the variability of renal and liver involvement.

Imaging the direct bidirectional spread of disease between the abdomen and the female pelvis via the subperitoneal space.

This report expands the concept of the subperitoneal space (SS) as the potential conduit for direct spread of disease in the abdomen to include the female pelvis. The normal anatomy of the SS in the lower abdomen, the female pelvis, and its uninterrupted continuation between the abdomen and pelvis are demonstrated by several imaging modalities.Surgically proven cases of bidirectional spread of disease between the abdomen and female pelvis are reported.The unifying concept of the interrelationship formed by the SS provides an understanding of the basic concepts of the pathways of direct spread of disease and the pathogenesis of the clinical presentation of disease distant from its site of origin.