Richard D. Kittredge

Systemic venous blood return via the portal vein.

The patterns of collateral circulation which develop following obstruction of the inferior vena cava have been classically divided into three groups depending upon the level of obstruction, i.e., infrarenal, middle caval, and upper caval. The portal vein can play an active role at all three levels. Multiple potential routes to the portal vein are described and 6 cases are presented.

Computed Tomography in Renal Transplant Problems

Nineteen patients were studied with computed tomography immediately after kidney transplantation and subsequently if declining renal function was noted. Abscess formation, hematoma and lymphocele were satisfactorily demonstrated. Of 8 diagnosed abnormal densities, 5 were proved correct (abscess 2; serous collection and old blood 1; lymphocele 1; and hematoma (fresh) 1). Two were not proved but abnormalities resolved on medical therapy. There was one incorrect diagnosis: what was thought to be an abnormal fluid collection was really a markedly enlarged edematous rejected kidney. Computed tomography represents an excellent method of following the course of therapy, whether surgical or conservative.

Computed tomography of the trachea: A review

Abstract An awareness of the tracheas normal shape, position, and relationship to other structures is necessary, and the clinician should beware of marked variations that are still normal. Normal variation may effectively mimic pathology. The effect of pathology on the trachea varies depending on the extent of the pathology.

The Role of Angiocardiography in Myxedema Heart Disease

In 1918, Zondek (26) reported cardiac change in a number of patients with myxedema, emphasizing the increase in heart size as demonstrated by x-ray examination. In 1939, Scherf and Boyd (20) described 3 cases of pericardial effusion in myxedematous patients, offering this as a common cause of the enlarged cardiac silhouette. In recent years, there have been several reports of this association in the literature, usually in isolated cases (2, 3, 4, 6, 10, 12, 17, 21, 26). Most often, the diagnosis was established by pericardiocentesis (9); in other instances, by postmortem examination. Of interest is the report of Lerman et al. (14), who cited postmortem records showing 2 of 5 myxedematous patients to have pericardial effusions. In 1953, Marks and Roof (16) reviewed the literature on pericardial effusion in myxedema. In 13 of 44 cases of myxedema reported, there were associated pleural or peritoneal effusions, or both. The purpose of this paper is to show how angiocardiography may be decisive in documenting...

Computed tomography in the renal transplant patient: problems in interpretation.

Fluid collections associated with a transplanted kidney can be easily imaged and classified by Hounsfield Unit (HU) into definite categories (2). However, in some entities HU measurements overlap, with differentiation on the basis of clinical course being difficult as well (1,3). This article is addressed to these problems. Although routine radiologic techniques may provide useful knowledge, the usually can add nothing to the definitive solution.

Arteriography in Ewing's Tumor

Abstract A case of Ewings tumor of bone with unusual clinical presentation is reported, and arteriographic aspects are discussed. Arteriography is a practical means of differentiating benign from malignant bone tumors, because pathological vessels, tumor spaces, and arteriovenous fistulae are found. The more inaccessible the lesion, the more valuable arteriography is in defining extent and accompanying mass of soft-tissue involvement.

One Aspect of Splenoportography: Reversal of Flow with Resulting Non-Visualization of the Portal Vein

It has been demonstrated experimentally and clinically that in cirrhosis the contrast material injected into the spleen during splenoportography may be diverted completely into the collateral circulation, passing and failing to visualize the portal vein and possibly the splenic vein as well. One of the most important rewards from splenoportography is the differentiation of intra- and extra-hepatic blocks relative to surgical correction. The two general methods of determining any splenic or portal obstruction roentgenographically consist in studying the visualized portions of these veins and analyzing the type of collateral circulation that is demonstrated (5). It has been noted that the most distal point of visualization of a vessel does not always indicate the site of the obstruction, particularly in the venous system. The discrepancy may be due to early exposure of film, before the injected contrast material has succeeded in traversing the area of nonvisualization. It is for this reason that serial roen...

AORTOGRAPHY PROBLEMS IN THE AGED PATIENT.

Arterial disease ranks among the most common ailments of man and accounts for more deaths than all diseases combined. The relative ease of visualization of virtually all major arterial channels of the body has been a major forward step in diagnosis and treatment. Advanced age of the patient is not a contraindication. Necessarily, as arteriosclerotic disease progresses to the stage of plaque formation, thrombosis or aneurysm, study by direct catheterization becomes more difficult (14). Other satisfactory methods of arteriography may be used in these cases ( 5 ) .