Ramesh B. Patel

Leuprolide acetate in the management of cesarean scar endometriosis

Background Progestin or estrogen-progestin combination therapy has not proven useful in the treatment of endometriosis of the abdominal scar after cesarean delivery. We report our experience in managing this condition with a gonadotropin agonist. Case A 22-year-old black woman with a history of two previous cesareans developed endometriosis of the abdominal scar. The extent of the lesion was estimated by computed tomographic (CT) scan, and a 6-month preoperative course of leuprolide acetate was administered. The patient exhibited prompt symptomatic response to the gonadotropin agonist, but the physical examination and CT scan findings were unchanged. Pathologic examination after surgical removal of the lesion confirmed the clinical diagnosis. Conclusion Leuprolide acetate administered to a patient with cesarean scar endometriosis was associated with an improvement in symptoms, but there was no change in lesion size.

Relative value of computed tomography and ultrasonography in the assessment of renal angiomyolipoma.

Imaging studies on six patients with known angiomyolipomas were reviewed to determine the contribution of each imaging modality to the preoperative diagnosis. A spectrum of clinical presentations from asymptomatic patients with tuberous sclerosis to acutely ill patients with flank pain and hypotension was included. Findings varied from multiple, small, bilateral intrarenal masses to single larger masses with extrarenal components. Computed tomography (CT) identified fat containing masses in all cases. Ultrasound showed hyperechoic masses in all four cases in which it was utilized. In addition, CT allowed diagnosis of associated hematomas and additional angiornyolipomas not seen on other studies. Ultrasound provided a noninvasive follow-up method without the use of ionizing radiation.

Focal fatty liver lesions in alcoholic liver disease: A broadened spectrum of CT appearances

The CT examinations of 26 consecutive alcoholic patients with focal fatty infiltration of the liver were analyzed. Five different patterns of focal fatty infiltration were noted. In most alcoholic patients these appearances present no diagnostic problem and further confirmation can be obtained by repeating the CT scan within 1–2 weeks to see if interval resolution occurs following enforced abstinence. In select instances, more invasive and definitive procedures such as superselective angiography or liver biopsy may be necessary to differentiate these findings from other more serious diseases they may closely resemble, such as primary or secondary liver neoplasms.

In utero sonographic findings in fetal renal vein thrombosis with calcifications

Since Rayers initial description of renal vein thrombosis, 1 numerous publications have dealt with various aspects of this disorder. Among the imaging modalities used to diagnose this condition are plain radiography, intravenous and retrograde pyelography, inferior venacavography, radionuclide renal scanning, and arteriog~ raphy. These modalities are used in both infants and adults. More recently, ultrasonography has been advocated as an important diagnostic tool. We describe antenatal ultrasonic findings in a case of fetal renal vein thrombosis with calcifications in the thrombi.

Echocardiographic diagnosis of left ventricular mural thrombi occurring in cardiomyopathy

Abstract A patient with alcoholic cardiomyopathy presented with recurrent biventricular heart failure. Echocardiography supported the clinical diagnosis and suggested the presence of multiple left ventricular mural thrombi. At postmortem large left ventricular and small right ventricular thrombi were found in association with systemic and pulmonary emboli. Echocardiography may be of value in the earlier detection of intramural left ventricular thrombi.

Evaluation of complex carpal trauma: Thin-section direct longitudinal computed tomography scanning through a plaster cast

Direct longitudinal computed tomography of the wrist, with a plaster cast on the forearm, is described. In a case of complex carpal injuries, the advantages of this method are compared with those of conventional radiographic studies.

Ectopic intracaval liver.

Congenital abnormalities of the liver are rare with prior descriptions of lobar or segmental agenesis, Reidels lobe, and ectopic hepatic lobes. Intrathoracic ectopic hepatic lobes have been reported in many instances; however, there is only one documented case of abnormally positioned liver tissue within the inferior vena cava (J Chapman-Fredricks, R Birusingh, M Ricci, M Rodriguez, Intracaval liver with cardiac extension. A new developmental anomaly? Fetal and Pediatric Pathology. 2010; 29:401-406). We report a second case of an ectopic intracaval liver defined as a mass in an adult who presented for abdominal pain and review the radiological findings.

Interstitial Lymphoscintigraphy for Diagnosis of Lymphocele

A patient with the development of a post-surgical mass in the thigh, at the site of surgery, is described. Lymphoscintigraphy was important in solving the clinical dilemma.

Computed tomography of complicated psoas abscess with intraabscess contrast medium injection.

Computed tomography in a case of tuberculous psoas abscess is described. Additional information useful in planning surgical drainage was obtained by intraabscess contrast medium injection through a draining sinus.

Computed Tomography Demonstration of Distal Femoral (Trochlear) Articular Groove: A Normal Variant

In computed tomography of the skeleton, as in other radiologic modalities, recognition of normal skeletal variants is essential for defining the extent and type of injury or neoplasm. Computed tomography findings, because of the unique use of cross-sectional anatomy, must be carefully studied to avoid labeling a normal variant as an abnormal entity. We describe here an observation of a normal variant-distal femoral, anterior articular (trochlear) groove-found in a patient with an osteochondral fracture and loose intra-articular bony fragment.