Wilhelm Z. Stern

Metastatic neoplasm to the kidney. A report of four cases studied with angiography and nephrotomography.

Metastatic neoplasm to the kidney is not uncommon, but it is unusual for a metastasis to the kidney to present as a solitary renal mass lesion or to cause urinary tract symptoms. We have had the opportunity to radiographically study four such lesions with angiography and nephrotomography. In all instances the angiogram revealed an avascular or hypo-vascular lesion while nephrotomography (performed in three cases) clearly indicated that the lesion was not a simple benign cyst. The presentation of the clinical and radiographic features of these cases forms the basis of this report. Case I: A 59-year-old male was admitted to the Boston University Hospital complaining of shortness of breath of two to three months duration. He also complained of a nonproductive cough and a gradual weight loss of thirty pounds during this period. He had been smoking three packs of cigarets a day for forty-six years. Positive findings on physical examination included a left supraclavicular node and mild clubbing of the fingers. ...

The ventriculopleural shunt procedure for hydrocephalus: Case report of an unusual complication

Summary A brief review of the simple ventriculopleural bypassing technique for the treatment of hydrocephalus is given and an unusual complication is reported.

Idiopathic Azygos Phlebectasia Simulating Mediastinal Tumor

The roentgen appearance of the normal azygos vein was first described by Ottonello in 1932. It casts an ovoid or almond-shaped shadow in the right tracheobronchial angle, seen to best advantage on frontal laminagrams of the chest. The width of the normal azygos vein in adults has been reported not to exceed 6 mm. (Fleischner and Udis). Dilatation of the azygos vein has been described under various pathologic circumstances, including right-sided heart failure, portal venous hypertension, obstruction of the superior or inferior vena cava, and absence of the inferior vena cava. Particularly in the latter case, the azygos and hemiazygos venous systems may serve as important collateral channels for return of blood to the right side of the heart. It is our purpose to record the case of a healthy 19-year-old white male who was rejected from military service because a routine induction chest roentgenogram revealed a “mediastinal tumor” (Fig. 1). At a subsequent exploratory thoracotomy, a huge azygos vein was foun...

Persistent Angiographic Abnormalities after Cure of Malignant Trophoblastic Disease

Recent advances in angiography have extended into the area of trophoblastic neoplasms, including benign hydatidiform mole, chorioadenoma destruens (malignant hydatidiform mole), and choriocarcinoma. This communication is prompted by the recent observation of a patient in whom a benign hydatidiform mole developed, complicated by a chorioadenoma destruens, which was cured by chemotherapy. Borell et al. (1) have shown by angiography the transition from hydatidiform mole to choriocarcinoma in two patients, while Cockshott and Hendrickse (3) have reported persistent arteriovenous fistulas following chemotherapy of malignant trophoblastic disease in seven patients. Most recently Leibold et al. (6) have reported the surgical excision of a pelvic arteriovenous fistula several years after successful treatment of a chorionepithelioma. In the present case each of the three stages (benign mole, chorioadenoma destruens, and the status after successful chemotherapy) is documented angiographically and verified histologi...

Multiple calcified aneurysms in coarctation of the aorta.

Abstract Two female patients in their sixth decades presented with multiple calcified aneurysms involving collateral thoracic arterial channels in association with coarctation of the aorta. The roentgen signs of coarctation of the aorta in the child and in the adult are briefly listed. The differential diagnosis of superior mediastinal calcifications is discussed, and the importance of careful inspection of the roentgenograms in a search for rib notching is emphasized. While rib notching is only suggestive of aortic coarctation, its combination with calcified aneurysms of the brachiocephalic arteries is practically pathognomonic.

Posterior Mediastinal Goiter

The posterior mediastinum is an infrequent site for an enlarged thyroid. A correct preoperative diagnosis is required, so that the proper surgical approach may be used. Five cases of posterior mediastinal goiter will be presented and the current literature reviewed. Case I: A 68-year-old white female was seen in 1953, with a history of a mass in the neck since 1914. In 1936, a subtotal thyroidectomy had been performed. A nonproductive cough persisted after the thyroidectomy and was associated with some exertional dyspnea and substernal wheezing. More recently, auricular fibrillation had developed. On roentgen examination of the chest in the posteroanterior postion (Fig. 1), a mediastinal mass was seen bilaterally, projecting more toward the right. The trachea was displaced to the right and compressed. A frontal plane film with barium (Fig. 2) showed the esophagus to be displaced to the right. On the oblique and lateral projections (Figs. 3 and 4) the trachea was bowed forward and the esophagus displaced p...

Positional relation of gallbladder to hepatic flexure

Conclusions1. A close anatomic relationship exists roentgenologically between the gallbladder and hepatic flexure of the colon, as shown in a series of 419 cases.2. This approximation is of practical importance in the evaluation of calcareous deposits in the right upper quadrant of the abdomen.3. The proximity between the gallbladder and hepatic flexure may be of assistance in locating a faintly opacified gallbladder during cholecystography.

Posterior migration of a herniated disk.

This report is made to record the occurrence of an extruded disk migrating to the dorsal extradural space at the level of L3-L4. In a recent survey of the literature, Rubinstein, Stern, and Jacobson (2) reviewed the subject of blocking of the spinal canal, complete and incomplete, by extruded disks. In no instance was the entire nucleus pulposus found dorsal to the thecal sac. Case Report A 39-year-old-male was seen nine days after experiencing a sudden pain in the left calf, upon getting out of bed in the morning. This was so severe that the patient was immediately incapacitated; it subsequently spread to the right buttock and was accompanied by weakness of both legs which soon progressed to complete inability to walk. Two days prior to hospital admission bladder and bowel function failed. The patient was an extremely obese, heavily built man, apparently suffering intense discomfort, with abdominal distention and urinary retention. There was tenderness on deep pressure over the mid-lumbar area, and the s...