Nancy S. Curry

Complications of nasoenteric feeding tubes

Small-bore, silicone nasoenteric feeding tubes are increasingly utilized in the critically ill patient to provide nutritional support. The metallic-weighted tips and stiffening introducing stylets create the potential for misplacement with potentially serious consequences. We have reported our experience with 14 patients who had inadvertent tube misplacement, resulting in complications that included pneumothorax, hydrothorax, empyema, mediastinitis, pneumonia, and esophageal perforation. The incidence of radiographically detected abnormal tube position was 1.3 percent. The presence of cuffed tracheostomy or endotracheal tubes did not prevent this occurrence. The institution of enteral feedings should, therefore, be performed according to strict guidelines which include radiographic confirmation of desired position before feedings are initiated, limited and supervised use of stylets, and a need for special precautions in patients who are obtunded or receiving intubated respiratory assistance.

Clinical Spectrum of Adrenal Myelolipoma: Analysis of 8 Tumors in 7 Patients

Adrenal myelolipoma is a rare, benign, and biochemically nonfunctioning tumor. Most patients with adrenal myelolipoma are asymptomatic and the condition is discovered incidentally at autopsy. Review of the literature reveals 70 patients with surgically documented adrenal myelolipoma. We report 7 additional patients with 8 adrenal myelolipomas, of whom 5 underwent surgical removal because of tumor size, unusual imaging features or symptomatology. Of our patients 4 had symptomatic lesions requiring surgical removal, while 1 had an adrenal myelolipoma that was discovered intraoperatively. Of the remaining 2 patients 1 had a small (3 cm.) lesion discovered incidentally on excretory urography and 1 had bilateral adrenal myelolipoma discovered incidentally on computerized tomography.

RADIOLOGIC EVALUATION OF SMALL AND INDETERMINANT RENAL MASSES

A common problem in radiologic and urologic practice today is what to do with the small or indeterminant renal mass. Whether found incidentally or sought after because of patient symptomatology, these lesions present a challenge in diagnosis and management. This article outlines the scope of the problem, illustrates representative lesions, suggests imaging and management strategies culled from personal experience, and provides a review of available literature.

Isolated lymphoma of genitourinary tract and adrenals

With the routine use of computed tomographic imaging, intrinsic involvement of the genitourinary tract in newly diagnosed non-Hodgkins lymphoma is seen in as many as 10 percent of patients. Incidental discovery of an extranodal, extra-lymphatic lesion in the genitourinary tract without clinical or radiographic evidence of disease elsewhere, however, is an uncommon occurrence. The clinical presentation and imaging findings in 4 patients with initial manifestation of lymphoma isolated to the kidney, ureter, bladder, and adrenals, respectively, are presented. These patients had no evidence of lymphoma elsewhere, and imaging studies mimicked the more common neoplasms affecting these organs.

The Effect of Drainage Tube Size on Adequacy of Percutaneous Abscess Drainage

Fifty-one patients with documented abdominal abscess cavities were treated by percutaneous abscess and fluid drainage (PAFD). Drainage catheters made of various materials in sizes ranging from 5 through 18 French (Fr) were retrospectively studied and prospectively assigned to patients. No significant difference in the success or failure of PAFD as a function of these factors was found once an 8.3 Fr catheter with 0.045-inch diameter sideholes was reached; catheters larger than this were not associated with improved patient outcome. Failues of PAFD occurred primarily with the presence of phlegmonouscollections and cavities with fistulous connection to bowel.

Hemorrhagic renal angiomyolipoma: Superselective renal arterial embolization for preservation of renal function

A 35-year-old woman with tuberous sclerosis and known bilateral renal angiomyolipomas presented with shock due to massive hematuria arising from the left kidney. The cause of bleeding was diagnosed angiographically as arising from a left upper pole renal artery aneurysm within the tumor. Cessation of bleeding and clinical stabilization occurred without deterioration of renal function after superselective embolization of the dorsal segmental renal artery with a single 5-mm Gianturco coil.

Unilateral renal cystic disease in an adult

Unilateral renal cystic disease (URCD) is a rare, nonfamilial, nonprogressive, unilateral cystic disorder of the kidney. Very few adults with this condition have been documented [1–4]. We describe a case with a 30 year radiologic follow-up. Absence of a family history of cystic renal disease, benign clinical course through adulthood, and limitation of the process to one kidney distinguish this condition from asymmetric autosomal dominant polycystic kidney disease (ADPKD).

Renal metastases from osteogenic sarcoma

A clinically and radiographically unsuspected ossified renal metastasis from a primary osteogenic sarcoma was identified by computed tomography (CT) and radionuclide bone scan. These imaging modalities play an important adjunctive role in the evaluation and follow-up of patients with primary osteogenic sarcoma.

Atypical cystic renal masses

Atypical cystic renal masses continue to be a challenge to the radiologist despite advances in imaging technology. Renal masses that appear cystic on imaging studies include a large variety of lesions but, from a practical standpoint, the most important task for the radiologist is making the critical differentiation between atypical benign cysts and cystic tumors. Statistically, most cystic lesions of the kidney are simple benign cortical cysts with classic characteristics. Occasionally, however, these masses defy diagnosis because of overlap in appearance between benign and malignant lesions. The purpose of this article is to review the presentation of atypical cystic masses, discuss the appropriate use and limitations of diagnostic procedures in their evaluation, and discuss the controversies in managing these interesting lesions.

Hyperdense renal mass: Unusual CT appearance of a benign renal cyst

The following case report documents the unique manifestation of a solidified renal cyst as a homogeneously hyperdense renal mass on computed tomography. Surgical and pathologic verification of this benign lesion are discussed.