Theodore R. Smith

The cisterna chyli:Incidence and characteristics on CT

The objective of this study was primarily to determine the incidence of the cisterna chyli (CC) on computed tomography (CT). Its radiologic characteristics were also evaluated. Retrospective review of 403 randomly chosen CT cases was made. All patients received intravenous contrast. Note was made of incidence, location, size, attenuation values, slice thickness, age, sex, and the presence or absence of malignancy or adenopathy. There were seven cases of demonstrated CC (1.7%). It was variably located at the L2 to T11 levels; average attenuation was 4 H and average size was 7.4 mm AP by 7.0 mm in transverse diameter with rounded to elliptical shape. Average length of CC was 1.5 mm. Malignant primary was present in four of the seven cases, and none of the seven had adenopathy. There were three males and four females; average age of the CC group was 55.5 years. Visualization of the CC on CT is not rare (1.7%); as previously reported, it should be distinguished from retrocrural adenopathy by its low water attenuation, anatomic continuity with the thoracic duct, tubular nature, and lack of intravenous contrast enhancement.

Malignant peritoneal mesothelioma: Marked variability of CT findings

Three pathologically proven cases of malignant peritoneal mesothelioma (MPM) are shown with markedly different computed tomographic (CT) appearances. The first presented as a large enhancing pancreatic mass, a second with diffuse solid large intraperitoneal masses enveloping bowel and mesentery, and a third with predominance of ascites and small peritoneal nodules. In only one patient was there a history of possible asbestos exposure. The CT findings, pathology, and differential diagnosis of MPM are discussed.

Comparison of computed tomography and contrast enema evaluation of diverticulitis

A total of 31 patients with diverticulitis were analyzed who had both computed tomography and contrast enema. There was almost equal sensitivity to abnormality of approximately 90 percent. Contrast enema produced a specific diagnosis of diverticulitis in 61 percent, using stringent positive criteria, and an additional 29 percent with suggestive findings. Comparative computed tomography specific diagnoses in those 31 cases was made in 65 percent, and suggestive in 23 percent. Computed tomography was particularly useful diagnostically in cases of retrograde obstruction on contrast enema. The authors conclude that contrast enema should be the primary mode of approach, while computed tomography can be a valuable follow-up when the diagnosis is still in doubt, or if it is possible that patient management might be altered by additional information.

Actinomycosis of the distal colon and rectum

Actinomycosis of the colon has rarely been reported; two such cases are presented. A predisposing factor appears to be the presence of a preexisting intrauterine device (IUD). This history was present in one case in which there was perisigmoid abscess, local extension, and fistulous tract or the anterior abdominal wall. A second patient had anorectal involvement which resembled Crohns disease, and was found to be HIV positive. There was mucosal irregularity, wall thickening, reactive adenopathy, perirectal fascial thickening, and a sinus tract, which responded well to penicillin. It is unclear if there is an increased incidence of clinical actinomycosis in the HIV positive population, as it has not to our knowledge been previously reported.

CT demonstration of a giant colonic diverticulum

A case of giant sigmoid colonic diverticulum (GCD) is presented in which plain films showed an unchanging persistent large gas collection that did not opacify on barium enema. The computed tomographic scan revealed the GCD in close apposition to the adjacent sigmoid diverticulosis. Its walls were thin and more irregular than noted on plain films, and there was a suggestion of intraluminal contrast within it.

Radiographic and clinical sequelae of the duodenocolic anatomic relationship: two cases of Crohn's disease with fistulization to the duodenum.

SummaryThe posterior surface of the proximal transverse colon and the anterior surface of the descending duodenum are intimately related. The clinical importance of this apposition is re-emphasized with presentation of two cases which had the uncommon phenomenon of benign duodenocolic fistula. These two rare cases of duodenocolic fistulas secondary to Crohns disease are added to the literature. It is also suggested that in some cases, duodenal mucosal alterations with adjacent Crohns disease of the colon might be the result of reactive inflammatory changes, and do not necessarily indicate contiguous extension of the granulomatous disease.

Adenocarcinoma arising in Crohn's disease: report of two cases.

Crohn’s disease of the colon and small bowel is associated with a greater-than-chance increased incidence of adenocarcinoma, which also differs from the norm in age and anatomic distribution. The cancer risk appears to rise with earlier age of onset and long duration of the granulomatous disease, and the prognosis is relatively poor, probably due to difficulty in diagnosis because of the overlapping Crohn’s disease. Two additional cases of adenocarcinoma arising in Crohn’s disease are described.

Anomalous inferior vena cava associated with horseshoe kidneys

Two cases are presented in which anomalies of the inferior vena cava were associated with horseshoe kidneys. Radiological demonstration of such combined variation is rare, only one case of duplicated inferior vena cava with horseshoe kidney having been found in the literature. The embryological basis for these anomalies is reviewed. A possible explanation for their coexisting occurrence is also speculatively raised.

Transformation of a pedunculated colonic polyp to adenocarcinoma? Report of a case.

SummaryA 2-cm colonic polyp on a substantial stalk was clearly visible on barium-enema examination in 1964. In 1966, follow-up examination showed no change. Two years later, a small sessile carcinoma was demonstrated at the same site and resected. No residual stalk or benign adenomatous tissue was seen within the small, superficial, sharply demarcated carcinoma. A brief summary of the benign adenoma-carcinoma controversy is presented, along with a discussion of how the present case might be interpreted.

Multiple leiomyosarcoma of the transverse colon: report of a case and discussion.

A case is described of a patient found, at operation, to have two infiltrating leimyosarcomas in the transverse colon. Study indicated them to be two separate primary lesions. Literature on leiomyosarcoma is reviewed.