Miriam Katz

Spiral CT and 3D image reconstruction of vascular rings and associated tracheobronchial anomalies

Objective Spiral CT (SCT) angiography and three-dimensional (3D) reconstruction methods represent noninvasive tools in diagnosis of vascular rings and associated tracheobronchial anomalies in the pediatric age group. Materials and Methods Three patients suspected on clinical and conventional radiological grounds of having vascular and tracheobronchial anomalies were examined using SCT. Three-dimensional images were reconstructed using a surface rendering technique. Results In one case the diagnosis of complete double aortic arch was confirmed by angiography. In the other two patients the SCT and 3D reconstruction established the diagnosis of pulmonary sling and right aortic arch associated with left aberrant subclavian artery and angiography could be avoided. Conclusion Spiral CT and color-coded 3D reconstruction represent important additional tools and perhaps alternatives to angiography or other noninvasive techniques used in evaluation of vascular anomalies of the thoracic aorta and pulmonary arteries in infants and children.

Effect of Increased Dialysate Volume on Peritoneal Surface Area among Peritoneal Dialysis Patients

Large dialysate volumes are often required to increase solute clearance for peritoneal dialysis patients. The resulting increase in solute clearance might be attributable to an increased plasma-to-dialysate concentration gradient and/or to an increased effective peritoneal surface area. One of the factors affecting the latter is the peritoneal surface area in contact with dialysate (PSA-CD). The aim of this study was to estimate the change in PSA-CD after a 50% increase in the instilled dialysate volume for patients undergoing peritoneal dialysis. PSA-CD was estimated by using a method applying stereologic techniques to computed tomographic (CT) scans of the peritoneal space. The peritoneal cavity of 10 peritoneal dialysis patients was filled with a solution containing dialysate, half-isotonic saline solution, and contrast medium. Peritoneal function tests and CT scanning of the abdomen were performed twice for each patient (with an interval of 1 wk), after instillation of a 2- or 3-L solution. Scanning of thin helical CT sections was performed, and 36 random sections of the abdomen were obtained after reconstruction. A grid was superimposed on the sections. The surface area was estimated by using stereologic methods. After instillation of the 2-L solution, the volume of the peritoneal solution at the time of CT scanning was 2.32 +/- 0.05 L. The PSA-CD was 0.57 +/- 0.03 m(2), ranging from 0.41 to 0.76 m(2). The use of the 3-L solution increased the peritoneal volume by 46 +/- 2%. PSA-CD increased by 18 +/- 2.3% to 0.67 +/- 0.04 m(2) (range, 0.49 to 0.84 m(2); P < 0.01). Creatinine mass transfer increased from 112 +/- 10 mg to 142 +/- 11 mg (P < 0.0001). The slope of the change of the plasma-to-dialysate creatinine concentration gradient with time decreased from -2.26 +/- 0.23 x 10(-2) to -1.97 +/- 0.16 x 10(-2) (P = 0.01). K(BD-0) (permeability-surface area product or mass area transfer coefficient at time 0 of the dwell) increased from 10.6 +/- 0.7 to 13.6 +/- 1.2 ml/min (P < 0.02). These data demonstrate that increasing the instilled dialysate volume by 50% for peritoneal dialysis patients results in significant increases in the PSA-CD and K(BD).

Pectoralis major rupture in the elderly:Clinical and sonographic findings

We describe clinical and sonographic features of pectoralis major rupture in the elderly, which is relatively rare and unknown. Patients presented with a large pectoral ecchymosis extending to the axilla, chest wall, breast and arm. The pectoral area was sensitive, sometimes with a visible and palpable defect in the axilla. Ultrasound examination showed a large hypoechoic, well-circumscribed structure representing a hematoma within the pectoralis major muscle, partially replacing the normal echo muscle pattern. Ultrasonography is a useful, low cost diagnostic tool, and is recommended in the investigation of pectoralis major rupture in the elderly.

Asymptomatic diaphragmatic hiatal Herniation of the pancreas

Herniation of the pancreas into a diaphragmatic hiatal hernia is a rare condition reported in only three cases; all were symptomatic. We present a CT diagnosis of hiatal hernia containing the body and tail of a normal pancreas in an asymptomatic patient.

Sonographic features of dialysis-related amyloidosis of the shoulder.

This study evaluated the diagnostic role of ultrasonography in dialysis‐related amyloidosis in shoulders of chronically hemodialyzed patients. Fourteen shoulders of 12 long‐term hemodialysis patients were examined. All patients had been on dialysis for at least 10 years. All patients had varying degrees of pain and limitations of movement in the studied shoulders. Dialysis‐related amyloidosis was the presumed diagnosis in all patients. Any patient with a history of any disease, other than dialysis‐related amyloidosis, capable of producing a pathologic shoulder condition was excluded. The following parameters were studied: supraspinatus and biceps tendon thickness, tendon tears, synovial thickening, and the presence of hypoechoic material around tendons and within bursae. All shoulders had a nonhomogeneous thickening, greater than 7 mm, of the supraspinatus tendon. Seven shoulders (50%) had abnormal thickening of the biceps tendon (4 mm or greater), and two shoulders had abnormal thickening of the subscapularis tendon. Hypoechoic deposits were seen in the subdeltoid bursae and biceps sheaths in five and six shoulders, respectively. Three shoulders showed partial tears of the supraspinatus tendon, one shoulder showed a tear in the biceps tendon, and one shoulder had a tear in the subscapularis tendon. Ultrasonography is an excellent imaging modality in diagnosing the presence of dialysis‐related amyloidosis in symptomatic shoulders of long‐term hemodialysis patients, without having to resort to invasive procedures. The results of previous studies have been confirmed and new ultrasonographic findings described. Of particular interest is the involvement of the subscapularis tendon in dialysis‐related amyloidosis. Repeat ultrasonography can become an important way to follow‐up progression of shoulder dialysis‐related amyloidosis in hemodialyzed patients.