Peter J. Sones

The computed tomography‐guided adrenal biopsy: An alternative to surgery in adrenal mass diagnosis

A series of 16 patients with adrenal masses were biopsied percutaneously under computed tomography (CT) guidance with 18‐ to 22‐gauge modified Chiba needles. Adrenal adenomas, cysts, metastases, melanoma, and adrenal hemorrhage were identified. Of nine oncologic patients, four had adrenal metastases, while five had other nonmalignant adrenal masses. Thus, an adrenal mass in an oncologic patient is not always metastases. No complications occurred. The diagnostic evaluation of an adrenal mass in selected cases should include CT‐guided percutaneous aspiration as a safe and reliable alternative to open surgical biopsy. CT‐guided biopsy can be performed as an outpatient procedure, avoiding the cost of hospitalization and the morbidity of surgery.

The detection of inferior vena caval thrombosis with computed tomography.

Two cases are reported in which computed tomography demonstrated inferior vena caval thrombosis following intravenous administration of contrast material. This observation appears to have its greatest application in the staging of abdominal neoplasms, particularly renal-cell carcinoma.

Portaprival Collaterals Following Distal Splenorenal Shunt Incidence, Magnitude and Associated Portal Perfusion Changes

Collateral venous pathways develop between the high pressure portal vein and low pressure splenic vein following distal splenorenal shunt. This review of angiography in 50 patients with cirrhosis prior to and 1 year after DSRS shows that 98% developed collaterals: 72% transpancreatic, 48% transgastric, and 46% colonic. Multiple pathways developed in 64% of patients. Grading of the size of these collaterals showed that in 74% these exceeded the size of the portal and/or superior mesenteric vein. The effect of these collaterals on portal perfusion showed that 32% lost perfusion at 1 year, but significantly (P less than 0.05) more alcoholics (48%) lost perfusion than nonalcoholics (16%). The size, site and number of collaterals was not different between etiologies. Late follow-up in a subset of 32 of the patients showed no change in the site, and minimal increase in size of the collaterals at 3-11 years, with no further loss of portal perfusion. We conclude that virtually all patients develop collaterals after DSRS, these are along predictable pathways and are of significant size in the majority. However, development of collaterals per se does not equate to loss of portal venous flow, and a stable pattern is set in the first year after shunt. Characterization of these pathways will permit new approaches to minimizing their development.

Evaluation of the left renal vein in candidates for splenorenal shunts.

The authors describe 4 patients who had functioning distal splenorenal shunts despite obstruction of the left renal vein at its insertion into the inferior vena cava. The angiographic technique and findings of left renal vein evaluation in 40 shunted patients are reviewed. There were two important findings. First, no correlation existed between the degree of portal hypertension and the degree of filling of collateral tributaries of renal veins. Second, obstruction of the left renal vein does not impair a splenorenal shunt if good collateral pathways are present.

Computed tomography of the pancreas: The use of intravenous contrast to define the dorsal surface of the pancreas

After a non-selective review of 80 abdominal CT examinations, it was found that the use of intravenous contrast markedly improves the recognition of the superior mesenteric vein and the splenic vein. These veins lie adjacent to the posterior surface of the pancreas. When the pancreas is poorly seen due to inadequate retroperitoneal fat, when pancreatic size is borderline, or when pancreatic ductal obstruction is suspected on scans prior to intravenous contrast administration, the use of contrast may resolve the uncertainty.

Selective embolization of a stenotic intrarenal artery for control of hypertension

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