Rogelio Moncada

Neonatal ascites associated with urinary outlet obstruction (urine ascites).

Severe abdominal distention at birth is usually a serious life-threatening condition. When diagnosed in the uterine cavity before delivery the problem of soft-tissue dystocia arises (8). The etiology of an enlarged fetal abdomen in the third trimester of gestational development is usually one of the following conditions: enterogenous tumor, teratoma, polycystic kidney, neuroblastoma, Wilmss tumor, polycystic disease or large neoplasm of the liver, hydrometrocolpos, ovarian tumor, generalized edema from hemolytic disease or maternal diabetes, absence of abdominal muscles, massive hydronephrosis, or ascites (7). Ascites is the rarest etiology of a distended abdomen in the neonatal period. It is interesting to note that approximately 200 ml of fluid must be present in the peritoneal cavity before ascites becomes evident clinically. As early as 1894 Fordyce (2) published a review of fetal and neonatal ascites. Among 63 cases he collected from the literature, 17 had urinary tract abnormalities accompanied by ...

Intramural hematoma of the esophagus: a pictorial essay

Intramural hematoma of the esophagus (IHE) is a rare but well-documented condition that is part of the spectrum of esophageal injuries which includes the more common Mallory–Weiss tear and Boerhaave’s syndrome. Acute retrosternal or epigastric pain is a common clinical feature, which can be accompanied by dysphagia, odynophagia, or hematemesis. An early differentiation from Mallory–Weiss tear, Boerhaave syndrome, ruptured aortic aneurysm, aortic dissection, acute myocardial infarction, or pulmonary pathology can be difficult. Computed tomography (CT) is the imaging modality of choice and characteristically reveals a concentric or eccentric thickening of the esophageal wall with well-defined borders and variable degree of obliteration of the lumen. Measurement of the attenuation values within the lesion will reveal blood density which varies according to the age of the hematoma. CT should be considered the preferred diagnostic technique, thereby facilitating proper clinical management. Early diagnosis is crucial as most patients maybe treated conservatively with good outcome.

Contrast media-induced lipid peroxidation in the rat kidney.

Lipid peroxidation of biological membranes is often implicated in tissue injury. The authors compared the effects of ionic and nonionic contrast media (CM) on the induction of lipid peroxidation in rat kidney and its impact on renal function. Male Wistar rats weighing 200 to 230 grams were dehydrated for 24 hours and divided into 6 groups (n = 15/group). On day 0, groups 1 through 3 were injected with 25% glycerol (10 mL/kg, im) and rats from groups 4 through 6 received an equivalent amount of intramuscular saline. The next day, rats from groups 1 and 4 were injected with normal saline (10 mL/kg, iv); groups 2 and 5 received the ionic CM, diatrizoate, and groups 3 and 6 received the nonionic CM, iopromide. Each CM was tested at 10 mL/kg BW. At 24-hour intervals, 5 rats from each group were sacrificed. In rats injected with CM (diatrizoate or iopromide) alone, no changes in serum creatinine or kidney structure were demonstrated. In glycerol treated rats, a peak in serum creatinine was seen on day 2 which returned to normal level by day 4. Histologic changes included focal tubular damage and intraluminal debris. Malondialdehyde (MDA), a marker of lipid peroxidation concentration was higher than in controls (P less than 0.05). In diatrizoate-injected rats, increase in serum creatinine on day 4 was ten times higher than glycerol; severe morphological alterations in proximal tubules were noted and significant increases in renal MDA concentration were obtained (P less than .05). Iopromide (on day 4), caused a five-fold increase in serum creatinine compared with glycerol.(ABSTRACT TRUNCATED AT 250 WORDS)

Congenital and acquired lung hernias

Lung hernia is defined as a protrusion of lung parenchyma beyond the confines of the musculoskeletal thorax. Lung hernias can be classified according to location (i.e., cervical, thoracic, or diaphragmatic) and etiology. Approximately 80% of reported cases of lung hernia are acquired, usually related to trauma or surgery. Symptoms are few, infrequent, and vague. A painless, local, and inconstant bulging is evident on physical examination. The diagnosis of a lung herniation is accomplished using chest radiographs in the most cases. Surgery is usually reserved for large hernias or incarcerated hernias.

Computed tomography staging of renal carcinoma.

The ability of fast third-and fourth-generation scanning devices to supply images of sufficient quality to delineate the kidney, its vascular supply, and surrounding fascial envelope has provided a modality which permits preoperative staging of tumors of the kidney with an accuracy of about 90% in limited series of 20 specimen cases. The unreliability of bolus injection to evaluate tumor extension to the renal vein accounted for two errors.

Bilateral Adventitial Cystic Disease of the Popliteal Artery: A Case Report

Adventitial cystic disease (ACD) of the popliteal artery is an uncommon vascular condition of unknown etiology. In the present case report, we describe a case of bilateral ACD of the popliteal artery in a 58-year-old male. To the best of our knowledge, this is the first case of bilateral ACD of the popliteal artery reported in the literature.

Calcified metastases from malignant ovarian neoplasm. Review of the literature.

The authors describe the first case of calcified breast and axillary lymph node metastases from papillary serous cystadenocarcinoma of the ovary. The patient also exhibited psammomatous calcification in the pelvis. They also report the fourth case of curvilinear calcification of pseudomyxoma peritonei from pseudomucinous cystadenocarcinoma of the ovary. Inconsistencies in the literature regarding psammomatous calcification in benign ovarian papillary serous neoplasms are discussed, and the roentgenographic differentiation from other conditions is offered.

DIAGNOSIS OF DISSECTING AORTIC ANEURYSM BY COMPUTED TOMOGRAPHY

Computed tomography (CT) of the torso combined with simultaneous intravenous bolus injection of contrast media was used in sixteen patients suspected of having dissected their aorta. All patients had subsequent correlative percutaneous aortography within 24 h of the CT examination. Four patients proved to be normal, one had an aneurysm of the thoracic aorta, and eleven had aortic dissection (five type I, six type III dissection). All eleven patients with aortic dissections were diagnosed by CT and angiography; nine had spontaneous dissections and two had iatrogenic injuries to the aorta. Limitations of this imaging procedure include; inability to detect aortic valvular dysfunction and failure to provide an adequate perspective of aortic branch involvement. Potential benefits include: avoidance of aortogram in some cases, relative non-invasiveness, rapidity and ease of procedure, and less expense, radiation, contrast media, and discomfort to the patient. Early experience with CT-enhancement technique has reliably demonstrated normal as well as abnormal aortic wall morphology. It may have a place as an alternative to the conventional aortogram.

CT diagnosis of idiopathic aneurysms of the thoracic systemic veins.

Three patients with idiopathic aneurysms of the superior vena cava, left innominate vein, and inferior vena cava are presented. The advantages of CT over other diagnostic modalities are discussed.

CT findings in superior vena cava obstruction

T HE CLINICAL manifestations of SVCS were first described by Hunter in 1757, secondary to a syphilitic aneurysm of the ascending aorta.’ SVCS usually has an insidious presentation and eventually leads to a collection of signs and symptoms that together are diagnostic of the disorder. Obstruction of the SVC may result from external compression or intrinsic thrombotic disorders, and leads to proximal venous hypertension of varying magnitude. Clinically, the syndrome is manifested by: (1) the progressive dilatation of the veins of the upper trunk, arms, neck, and head; (2) increasing edema and plethora of the face, neck, upper torso, and breasts (Fig 1); (3) CNS disturbances with visual symptoms, syncope, dizziness, headaches, altered state of consciousness, and somnolence; (4) cyanosis and conjunctival edema; and (5) edema of the trachea and esophagus with respiratory distress and dysphagia. The development of the SVCS relates to the nature of the blood vessel as well as to the surrounding mediastinal anatomy. The SVC is a thin-walled structure without valves that drains