Richard B. Gordon

Anastomosis of the Internal Mammary Artery to the Distal Left Anterior Descending Coronary Artery

Postmortem studies suggest that segments of the left anterior descending coronary artery measuring 1.5 mm are rarely diseased. Bypass grafting to such segments has been performed in 31 patients. Ten patients having internal mammary to left anterior descending anastomosis have angiographically patent grafts 2 to 13 months after operation. Symptoms of angina as well as symptoms of left ventricular failure have been strikingly relieved.

Computed tomography of the abnormal appendix

This report describes the CT features of 29 abnormal appendices visualized during abdominal CT examinations. There were 22 cases of acute appendicitis, five mucoceles, and two mucinous adenocarcinomas of the appendix. The inflammed appendix appeared either as a fluid-filled slightly distended structure or as a collapsed small tubular structure. It was visualized on either cross or longitudinal sections and showed slight circumferential wall thickening. Periappendiceal inflammation was detected in 19 cases and intraluminal appendicoliths in six cases. Mucocele appeared as a larger fluid-filled round, oval, or tubular structure having a thin, sharp wall, low density contents, and no periappendiceal inflammation. Mucinous carcinoma appeared either as a single or as multiloculated, irregular shaped cystic lesion with solid elements. Infiltration of cecum and terminal ileum was seen in one case. In five cases the abnormal appendix was not recognized initially and was identified only after repeat 5 X 5 mm sections were obtained. During CT examination, demonstration of an abnormal appendix establishes the source of the abdominal pathology and helps greatly in the differential diagnosis.

Inflammatory aneurysm of aorta: Development documented by computed tomography

Aortic aneurysmal disease appears to be the central focus of the inflammatory process resulting in inflammatory aneurysm formation. Some authors believe that inflammatory aortic aneurysm disease is a distinct clinicopathologic entity; however, others have included it with retroperitoneal fibrosis. The histologic features of inflammatory aneurysm suggest an immunologic basis for the lesion, with the atherosclerotic aorta as a possible source of the allergen.

Intrinsic common bile duct stricture: an unusual presentation of retroperitoneal fibrosis

Retroperitoneal fibrosis is a rare disorder characterized by the presence of dense, grayish-white plaques centered about the abdominal aorta in the retroperitoneal space.1,2 Most commonly, it causes fibrous encasement of the ureters and subsequent obstructive uropathy leading to renal failure. Atypical sites of involvement include the small intestine, mesentery, duodenum, colon, urinary bladder, and epidural space.1 Typically, mass effect from the enlarging fibrous plaque leads to compromise of surrounding structures. For example, extrinsic compression can lead to small and large bowel obstruction, vena caval stasis, and arterial insufficiency in the lower extremities.1,3 The disease has an incidence of 1 in 200,000 and predominantly affects men, with a male to female gender ratio of 2-3 to 1.1,3 It generally presents in the fifth to sixth decades of life with dull noncolicky flank and back pain, weight loss, nausea, vomiting, malaise, hypertension and fever.1,3 Involvement of the common bile duct in this rare disorder is extremely uncommon. In this report we describe an unusual case of retroperitoneal fibrosis presenting with a malignant-appearing common bile duct stricture without a contiguous soft tissue mass or adenopathy on imaging studies.

Pseudoaneurysm with rupture in pancreatic pseudocyst wall as demonstrated by computed tomography

In chronic pancreatitis, inflammation originating in the pancreas may produce walled-off collections of fluid referred to as pseudocysts. This same histolytic process can also erode into adjacent arteries producing pseudoaneurysms that may hemorrhage secondary to rupture. The most common angiographic finding in patients bleeding secondary to pancreatitis is rupture of a pseudoaneurysm. We present a case of this condition that was first discovered incidentally by computed tomography during evaluation of a right renal carcinoma.

Unusual manifestations of carcinoma of the nasopharynx. A case report

A case of carcinoma of the nasopharynx which occurred in a 21‐year‐old Negro man is reported. He developed metastasis in the left humerus which simulated a primary bone tumor. This was studied by biopsy, angiography, and a strontium‐85 scan. He subsequently complained of pain in the right humerus. Angiography and strontium‐85 scan revealed metastasis in the bone before x‐ray verification. X‐ray therapy induced prompt pain relief.