Patrick J. Bryan

Respiratory movement of the pancreas: an ultrasonic study.

Respiratory movement of the pancreas was documented ultrasonically in 36 normal patients and volunteers. Pancreatic excursion from full inspiration to full expiration was measured in the plane of the superior mesenteric artery in supine, prone, and decubitus positions. Excursions ranged from 0 to 3.5 cm. The average respiratory excursion was 1.8 cm in the supine position, 1.9 cm when prone, and 2.2 cm in the lateral decubitus position. Such respiratory movement of the pancreas has obvious implications both for static B‐mode ultrasound scanning and for CT scanning.

MR imaging of uterine inversion.

Inversion of the uterus is a postpartum complication that is an obstetric emergency. This report describes a case of inversion of the uterus in which clinical evaluation was inconclusive, and magnetic resonance (MR) of the pelvis revealed findings virtually pathognomonic of incomplete inversion of the uterus with far greater conspicuity than on corresponding ultrasound. The MR findings directly resulted in earlier therapeutic intervention with a possible decrease in morbidity.

Initial experience with nuclear magnetic resonance (NMR) imaging of the human breast.

Two patients with breast abnormalities, one malignant and one benign, were studied with nuclear magnetic resonance (NMR) imaging utilizing a cryogenic superconducting magnet. Three-dimensional NMR images were obtained in one case and single slice planar images were obtained in the other. The NMR images correlated well with the corresponding mammograms. Although both conditions exhibited a different signal intensity for the area of abnormality compared to adjacent ductal and fatty tissue, the configuration of the abnormal areas allowed distinction between benign and malignant process.

MR imaging of osteochondral lesions of talus.

Ten patients with osteochondral lesions of the talus had magnetic resonance (MR) imaging to determine if this modality could accurately characterize the bone lesion and overlying articular cartilage. Eight patients had arthroscopy, five of whom also had arthrotomy. Magnetic resonance detected abnormal cartilage in all eight patients and disruption of cartilage in four of five, proven at surgery. One patient had disrupted cartilage at surgery not diagnosed by MR. Four patients had excision of the osteochondral fragment and curettage of the talar defect and in these patients MR accurately characterized the bony lesion. Three patients had conservative surgical procedures (drilling) and the extent of the bony lesion could not be determined at surgery. Magnetic resonance can accurately characterize the osteocartilaginous components of talus lesions and even though it should not replace plain radiography for diagnosis, it is ideally suited for evaluation of the articular cartilage and has proven to be useful in planning surgical procedures.

Ultrasound findings in the adreno-genital syndrome (congenital adrenal hyperplasia).

The adreno‐genital syndrome (congenital adrenal hyperplasia) is caused by deficiency of an enzyme (usually C‐21 hydroxylase) necessary for adrenal production of cortisol, which results in excessive accumulation of androgenic precursors. It is the most common cause of female pseudohermaphroditism. There have been a few sporadic reports of ultrasonic demonstration of enlarged adrenals in the adreno‐genital syndrome. To determine whether ultrasonography could be used to establish or exclude the diagnosis, ultrasonic examinations were performed on eight newborn infants with ambiguous genitalia who were subsequently proven to have the adreno‐genital syndrome. The adrenals were found to be enlarged in three patients, at the upper limit of normal in three patients, and in two infants the adrenals were well within normal limits in size. The uterus was identified in seven of the eight patients, but was not seen for technical reasons in one. It is concluded that ultrasound is useful in the evaluation of infants with congenital adrenal hyperplasia to establish the presence of a uterus and to demonstrate enlargement of the adrenals, but it should be cautioned that finding adrenals of normal size does not exclude the diagnosis. Key words ultrasound, adreno‐genital syndrome, congenital adrenal hyperplasia.

Computed tomography in unilateral extremity swelling of unusual cause.

Computed tomography (CT) was used in the evaluation of unilateral soft tissue swelling of unusual cause. Three patients with unilateral myositis are described and the diagnostic information provided by the CT scan is discussed. A fourth patient with lymphedema praecox and unilateral extremity swelling is presented.

Percutaneous Nephrostomy in Neonates and Infants

A total of 8 patients between 2 days and 2 years old underwent 13 percutaneous nephrostomies for treatment of hydronephrosis. No significant complications were encountered.