Robert L. Bree

Penetrating atherosclerotic ulcers of the thoracic aorta

Penetrating ulcer of the thoracic aorta is defined as an atherosclerotic lesion of the descending thoracic aorta with ulceration that penetrates the internal elastic lamina, allowing hematoma formation in the media. There is controversy whether this lesion differs from classic acute type III aortic dissection, based on its location, radiographic findings, natural history, and recommended therapeutic approach. Of 47 patients with a diagnosis of aortic dissection seen at our hospital during a 2-year period, five patients had clinical and radiographic findings of penetrating ulcer. Each of the five patients had characteristic computerized tomographic (CT) findings and two patients had angiographic confirmation. In all patients CT showed subintimal hemorrhage, aortic wall enhancement, absence of a double lumen, and contrast extravasation through the ulceration. In both patients who underwent angiography, ulceration, subintimal hematoma, and absence of a false lumen were demonstrated. The clinical presentation in four patients simulated acute aortic dissection or expanding thoracic aneurysm. The other patient, who was normotensive, did not have symptoms referable to the thoracic aorta but was studied because of an abnormal chest x-ray film. None of these five patients required surgical intervention. All five patients were alive and free of symptoms at 6 months, 8 months, 14 months (two patients), and 30 months after the original diagnosis. Follow-up CT scans in four patients showed resolution of subintimal hematoma and some dilatation of the lumen but no progression to rupture or aneurysm. Other authors stress the importance of differentiating symptomatic penetrating atherosclerotic ulcers from acute type III aortic dissection because of the higher incidence of rupture of penetrating ulcers and therefore recommend early surgical intervention.(ABSTRACT TRUNCATED AT 250 WORDS)

CT detection of adrenal lymphoma

We present 7 patients with lymphomatous involvement of the adrenal glands detected by computed tomography (CT). In all patients the adrenal glands were diffusely enlarged resulting in oval, round, or triangular shaped glands. In 6 of the 7 patients retroperitoneal adenopathy was present. Adrenal involvement previously ocuclt using conventional radiography should be detected more frequently using CT.

Inflammatory pseudotumor from sclerosing cholangitis.

We report the computed tomographic (CT) findings in a case of primary sclerosing cholangitis. A mass demonstrated on CT and ultrasound examination in the region of the common bile duct and extending into the head of the pancreas was shown to be diffuse fibrosis and thickening of the common bile duct at surgery.

Large infiltrating renal transitional cell carcinomas : CT and ultrasound features

A series of nine patients with large infiltrating renal transitional cell carcinomas is presented. These large tumors are rare but important in the differential diagnosis of renal masses. The average tumor size was 8.5 cm. In six patients the tumor involved almost the entire kidney. Seven masses were centrally located but two were peripheral. With CT the masses exhibited low attenuation relative to the normal or opposite renal parenchyma. Four masses exhibited necrosis. Lymphadenopathy, venous invasion, calcification, and spontaneous hemorrhage were all seen in this series. The major differential diagnostic possibility was renal cell carcinoma but lymphoma and metastatic disease were included. The diagnosis was confirmed in six patients by fine needle aspiration biopsy because of the presence of metastatic disease or the possibility of lymphoma. In the remaining three patients the diagnosis was made at surgery. The recognition that a large infiltrating renal mass may represent a transitional cell neoplasm is important in the eventual surgical management, and accurate preoperative diagnosis is stressed.

Computed tomography and ultrasound findings in Klippel-Trenaunay syndrome.

Computed tomography (CT) and ultrasound were used to evaluate two patients with Klippel-Trenaunay (K-T) syndrome. Bowel and bladder hemangiomas were demonstrated in these cases. Computed tomography demonstrated multiple low attenuation areas in the liver and spleen in one case. Computed tomography is capable of non-invasively demonstrating bowel and bladder wall hemangiomas in K-T syndrome. Both CT and ultrasound may reveal silent lesions in the upper abdominal viscera, such as liver and spleen.

Nongynecologic bladder and perivesical ultrasound.

Ultrasound is effective in evaluating pathologic entities in and around the urinary bladder. Abnormalities may be classified into 2 groups: lesions primarily affecting the bladder, including the bladder wall; and perivesical lesions, which secondarily affect the urinary tract. Intrinsic bladder diseases include inflammatory lesions, stones, and tumors, both primary and metastatic. Extrinsic perivesical abnormalities include lesions of the prostate, seminal vesicles, urethra, rectum, and perivesical soft tissues. Since the bladder is routinely visualized on pelvic ultrasonography, awareness and recognition of the ultrasonic appearance of disease in and around the urinary bladder can lead to more accurate diagnosis and detection of unsuspected disease.

Abdominal fine needle aspiration biopsies with CT and ultrasound guidance: Techniques, results and clinical implications

Experience with fine needle aspiration biopsy (FNAB) of solid intraabdominal masses with computed tomography and ultrasound guidance in 117 patients at a large community hospital is described. An overall accuracy of 86%, sensitivity of 86%, and specificity of 93% was obtained. FNAB was found to be safe and accurate and obviated the need for surgery in nearly 50% of patients. Further experience is required to assess the value of FNAB in solid renal masses and in abdominal lymphoma.