Robert M. Lowman

The ponticulus posticus of the first cervical vertebra.

The evaluation of anatomic landmarks is an important task of the radiologist because significant changes in these structures may be an index to underlying disease processes. The variations and asymmetrical deviations of such landmarks in size, shape, and contour are often many and confusing. For this reason they must be studied with care to insure adequate differentiation from disease processes. The extensive variations which may occur in the region of the craniocervical junction have been reviewed by McRae (6). Hoare (3) has also pointed out the importance of evaluating the grooves and foramina in the region of the posterior and lateral margins of the atlas and axis in vascular lesions of the posterior fossa and in lesions involving the cerebellum. It appeared desirable to us to evaluate the sulcus formed by the vertebral artery as it crosses the posterolateral laminar margin of the first cervical vertebra. After its exit from the transverse foramen, the vertebral artery passes over the posterior arch of...

Pigmented (melanotic) schwannomas of the spinal canal.

Primary pigmented neoplasms of the nervous system are rare tumors. The literature suggests that they behave aggressively and carry a guarded prognosis. We present 2 patients with pigmented schwannomas of spinal nerves who following therapy are alive, functioning and without evidence of tumor 14 and 17 years later. We wish to emphasize that the presence of melanin alone does not equate with a malignant course. The literature is reviewed and theories of histogenesis for these unusual lesions are discussed.

Brunner's gland adenoma of the duodenum

Three cases of large, polypoid Brunners gland adenoma are reported. These tumors arise from glandular tissue in the duodenum and often are associated with bleeding and abdominal discomfort. The radiologic, clinical, and pathologic features are reviewed.

Benign ulcer of the sigmoid colon. An unusual lesion that can simulate carcinoma.

Simple benign ulceration of the colon is an unusual condition that may simulate carcinoma clinically and radiologically, and complications usually develop before it is recognized clinically (3, 7, 12, 14, 15). Since the initial description by Cruveilhier (8) in 1835, 105 cases have been reported. 52 of them since 1928 (9, 12). Of this latter group, only 8 or 15 per cent were in the sigmoid. No specific etiology of the disease has been found, although it has been reported in systemic disease (13) and in a patient treated with a drug having known ulcerogenic properties (9). A report of this entity seems indicated so that radiologists will be aware of it, may differentiate it from malignant lesions, and may consider it in patients being treated with known ulcerogenic drugs. Case Report M. C., a 70-year-old white male, was admitted to the Yale-New Haven Hospital on Aug. 27, 1966, with severe rectal bleeding. The patient had suffered from severe arthritis of long duration, for which phenylbutazone, six tablets...

The roentgen aspects of intramural dissection of the esophagus. The mucosal stripe sign.

INTRAMURAL DISSECTION of the esophagus is an unusual type of rupture involving the mucosal layers of this viscus. The purpose of this report is to delineate the radiographic appearance of this entity following contrast studies and to emphasize the importance of differentiating it from the more ominous extraluminal perforation. The radiographic changes produced by intramural dissection of the esophagus may show a striking similarity to the typical roentgen findings in dissecting aneurysm of the aorta. In our case, true and false esophageal lumina were demonstrated, separated by a mucosal stripe resembling the appearance of the intima in aortic dissection. This finding differs from that seen in extraluminal rupture of the esophagus, which usually occurs as a longitudinal slit in the left posterolateral wall of the lower esophagus within 5 to 6 cm of the cardia. Radiographic signs of extraluminal extravasation of contrast media are virtually diagnostic of this potentially lethal condition when associated wit...

The angiographic patterns of the primary retroperitoneal tumors. The role of the lumbar arteries.

Abstract The lumbar and inferior intercostal arterial systems provide a major arterial supply of the retroperitoneal area, and abnormalities in their configuration, position, distribution, and size may indicate whether a mass is retroor intraperitoneal. In some instances, the histological nature of the mass may be predicted by the characteristics of its blood supply. Aortography with subsequent selective angiography to evaluate the feeding vessels and their branches is of value in the diagnosis of retroperitoneal masses.

Roentgen aspects of umbilical vascular catheterization in the newborn. The problem of catheter placement.

Radiographic examination represents the only method for the exact localization of intravascular catheters. There has been, however, no review of the technic of umbilical arterial and venous catheterization in newborn infants in the radiographic literature. Moreover, in the evaluation of films of infants with the respiratory distress syndrome, cardiac disorders, or abdominal abnormalities, the radiologist tends to concentrate on anatomical and physiological pathology and pays little attention to the localization or significance of catheters positioned below the diaphragm. Indeed, he may fail to consider the potential complications of the use of such catheters. Catheterization of the umbilical vein was utilized by Diamond et al. (1) in 1946 for the purpose of exchange transfusion in infants with erythroblastosis fetalis. Later, catheterization of the vein, as well as of the umbilical artery, was used for angiocardiography (3) and now is employed quite routinely for withdrawal of blood for gas analysis and f...

The esophageal lesions in dermatomyositis. A correlation of radiologic and pathologic findings.

The occurrence of the phenomenon of pseudodiverticulation or sacculation of segments of the gastrointestinal tract found in cases of scleroderma has not been previously reported in dermatomyositis. Few well documented correlations of the radiologic and pathologic lesions of the esophagus in dermatomyositis have appeared in the literature. Feldman and Marshak (5) were able to find only 6 cases with radiologic abnormalities of the esophagus (3, 6, 11), to which they added one case of their own. These authors noted that esophageal changes in these 7 cases were minimal in character, and they stressed the occurrence of small bowel dilatation. Subsequently, additional series of patients with this condition demonstrating abnormal esophageal function have been reported (4, 13). Histologic descriptions of the esophagus in dermatomyositis have rarely appeared in the literature (8, 11, 12, 14, 17), and since the lesions to be described here have not been previously documented and represent major abnormalities, we co...

Air Myelography for Demonstration of the Cervical Spinal Cord

The Demonstration of the cerebral ventricles and the subarachnoid spinal pathways by the direct introduction of air was first recognized and applied as a diagnostic procedure by Wideroe (20) and Dandy (4). Bingel and Jacobaeus (11) pointed out the value of air injection by means of the lumbar route and succeeded in demonstrating blockage of the spinal pathways in the lumbar and lower thoracic areas. Reichert (17) and Brockbank (1) used air as a contrast medium to demonstrate intraspinal structures, following the use of air myelography in the lumbar area by Coggeshall and von Storch (3) and by Van Wagenen (19). The method was also utilized by Chamberlain and Young (2) in the study of spinal lesions, especially those in the lumbo-caudal sac. Recently the demonstration of intraspinal dermoid tumors has been accomplished by List (14). Previous investigators have noted the presence of air in the upper cervical region following encephalography and occasionally ventriculography and have utilized this observation...

The potassium depletion states and postoperative ileus. The role of the potassium ion.

Abstract In 18 cases of postoperative ileus, the intestinal distension was significantly reduced after correction of hypokalemia. No one factor can be considered the sole etiology of the ileus, but the hypokalemia can be a contributory condition. The radiologist, when confronted with postoperative ileus, should keep this fact in mind.