Richard B. Hoffman

A New Method of Percutaneous Catheterization

Although the method of percutaneous catheterization described by Seldinger is a quick and safe tech-nic for introducing a catheter into the vascular system, the catheter must have a hole in the end to accommodate a guide wire. Closed-end catheters with side-holes are superior to open-end catheters for angiocardiography because they are less likely to recoil out of position during the injection, greater flow rates can be obtained by increasing the pressure of injection, and perforation of the myocardium during the injection is much less likely. Special closed-end catheters with solid flexible tips are especially valuable for crossing the aortic valve. These catheters cannot be passed over a guide wire as required by conventional percutaneous technics because they have no end-hole. Side-hole, dosed-end catheters are superior for aortography because the contrast medium can be directed into the vessel with less filling of extraneous vessels. Extraneous vessels often obscure the artery being studied. In order ...

Evaluation of Left Ventricular Enlargement in the Lateral Projection of the Chest

TEFT VENTRICULAR enlargement is probably the most frequent chamber enlargement in the adult heart, yet its detection is often difficult. According to Parkinson (3) the enlargement is more posterior than lateral in most patients. In all probability the left ventricle is enlarged in both directions in the majority of cases, but there are so many exceptions that roentgen studies in both posteroanterior and lateral views are commonly used. Eyler and his associates in 1959 (1) made an original and ingenious suggestion for the determination of left ventricular enlargement in the lateral view. They described an abnormal change in the relationship of the left ventricle to the inferior vena cava and the left leaf of the diaphragm. They noted that if the left ventricle extended posteriorly beyond the upper end of the vena cava more than 1.5 cm, it probably was a sign of left ventricular enlargement. It has been our experience, however, that the junction of the inferior vena cava and the right atrium is poorly defin...

Percutaneous catheterization in children.

Despite the widespread employment of the percutaneous method of catheterization and the voluminous amount of material appearing in the literature on the subject, little has been written about this important technic in children. The vast number of percutaneous vascular examinations are performed in adults for diagnosis and evaluation of the sequelae of atherosclerosis, i.e., stenosis and thrombosis. Because these represent degenerative changes, they are seldom found in the pediatric age group. This, no doubt, is one reason there has been little emphasis on the percutaneous method of vascular entry in children. Schobinger and Ruzicka (6) in their excellent book, Vascular Roentgenology, devote an entire chapter to angiography in children. They state that the percutaneous puncture of arteries in children is difficult and the examination must be performed as a rule after a cut-down. However, Lurie et al. (5) in 1963 reported in detail their experience with the Seldinger technic and concluded that examination o...

Pseudoseparation of bowel loops: a fallacious sign of intraperitoneal fluid.

The separation of air-containing bowel loops on the supine plain film of the abdomen has, for many years, been an accepted radiographic sign of intraperitoneal fluid and more recently has been stressed as a sign of bowel wall thickening. While Nelson and Eggleston, in their excellent paper on mesenteric vascular occlusion, alluded to the possibility of intraluminal fluid giving the appearance of separated bowel loops, they offered no evidence or explanation. Intraluminal fluid can produce the appearance of abnormal separation of the walls of adjacent bowel loops. We will refer to this phenomenon as pseudo-separation. Our attention was directed to this sign when we encountered it frequently in patients having nonspecific abdominal pain. We even observed it in scout films of asymptomatic patients who showed anxiety concerning an impending examination such as intravenous urography, aortography, or gastrointestinal studies. Figure 1, A, demonstrates a case in which the scout film clearly shows “separation” of...

A Simple Device for Exact Measurement of Lesions on the Angiogram

Abstract The author describes a simple method of measuring small vessels shown on angiograms, using a 5X loupe with a millimeter scale attached to one end. This technique facilitates easy and accurate assessment of “per cent stenosis” and true luminal diameter.

The routine use of subtraction in aortic arch studies.

Routine use of photographic subtraction in aortic arch or four-vessel studies can be valuable in uncovering unsuspected lesions and in cases in which clinical findings and unsubtracted radiographs are poorly correlated. Three cases are presented in which the correct diagnoses were made on subtraction prints but not on the unsubtracted radiographs. The technique is simple and can be used routinely in any radiology department.