Patricia A. Athey

Ultrasound diagnosis of hypertrophic pyloric stenosis

Thirty infants presenting with vomiting were examined sonographically. In 18 of these patients, a hypoechoic mass medial to the gallbladder and anterior to the right kidney was demonstrated. The mass measured more than 1 cm in diameter in all cases, with an average of 1.7 cm, and was interpreted as representing the hypertrophied muscle mass in pyloric stenosis. Sixteen of these infants had subsequent confirmation of this diagnosis by upper gastrointestinal tract examination and surgery. In two infants, both of whom had a small-diameter mass, the upper gastrointestinal tract study showed an atypical appearing pyloric canal; these two infants were thought to have atypical hypertrophic pyloric stenosis. Of importance technically is operator experience and patience and the use of different patient positions and even real-time imaging for completeness. Potential pitfalls include the fluid-filled duodenal bulb and gastric antrum, which cause a false positive diagnosis, and obscuration of a lesion by overlying bowel gas, which leads to a false negative diagnosis.

Massive hepatic necrosis in the hellp syndrome: Ct correlation

We present a patient with toxemia of pregnancy and the HELLP syndrome [hemolysis (H), elevated liver enzymes (EL), and a low platelet count (LP)] resulting in massive hepatic necrosis. Cross-sectional imaging, including sonography, computed tomography, and nuclear medicine, was instrumental in the diagnosis and differentiation from hepatic abnormalities of other pregnancy related entities especially acute fatty liver of pregnancy.

Aggressive infantile fibromatosis : pulmonary metastases documented by plain film and computed tomography

Aggressive infantile fibromatosis, one of the juvenile fibromatoses, is generally considered a benign lesion, but it does tend to recur locally because of its invasive nature. Distant metastases are considered rare. This case report documents pulmonary metastases arising 2 years after resection of the primary lesion from the thigh of an infant. This is the seventh reported case of distant metastasis from aggressive infantile fibromatosis. Computed tomography of the original lesion as well as the metastases are presented.

Metastasis to the bladder from pancreatic adenocarcinoma presenting with hematuria

Pancreatic adenocarcinoma infrequently involves the urinary tract. Hematuria may result from either direct invasion of the kidneys or from metastases to the urinary tract. The bladder may be involved in the late stages from metastases, but rarely is it associated with hematuria since mucosal involvement is very unusual. We report a second case of bladder metastases and hematuria as a presenting symptom of pancreatic carcinoma.

Abdominal cryptococcoma in AIDS: a case report

Cryptococcosis is a recognized opportunistic pathogen in the acquired immune deficiency syndrome. Although central nervous system infection and disseminated cryptococcosis is common in acquired immune deficiency syndrome, localized infection is rare. We present a case of massive retroperitoneal and mesenteric adenopathy in a male homosexual patient with acquired immune deficiency syndrome with clinical and radiologic features suggestive of lymphoma. However, this was proven pathologically to represent cryptococcal infiltration of the lymph nodes. Our experience indicates that Cryptococcus neoformans should be included in the differential diagnosis of massive abdominal adenopathy in the acquired immune deficiency syndrome.

Recurrent and metastatic retroperitoneal hemangiopericytoma

The computed tomography findings in a case of recurrent retroperitoneal hemangiopericytoma with an abdominal wall metastasis are reported. The lesions were well-circumscribed solid masses with varying computed tomography densities. The computed tomography findings in hemangiopericytoma are not pathognomonic; however, a patient with a history of this tumor, computed tomography can suggest recurrence or metastasis and define the location and extent of disease prior to surgical intervention.

Abdominal Approach to Pelvic Sonography

Sonography is an imaging modality that utilizes high-frequency sound waves. The sound waves are produced by a crystal within the transducer, a hand-held device that is placed in contact with the area of the body to be scanned. Gel is placed on the patient’s skin to ensure good transmission of sound into the body. Each time the sound beam strikes tissue interfaces, an echo will be produced and displayed on a monitor as a dot (either black or white), the intensity of which corresponds to its brightness. The combination of innumerable echoes gives a textural and anatomic representation of the structures scanned.