Yacov Itzchak

Duodenal varices in extrahepatic portal obstruction.

Duodenal varices were angiographically demonstrated in 18 cases of extrahepatic obstruction of the portal vein or obstruction of the splenic vein. In 11 cases, barium examination of the upper gastrointestinal tract revealed prominent filling defects in the duodenal bulb and the duodenal sweep. These abnormalities share common characteristics and differ in their appearance from more commonly diagnosed duodenal lesions; their demonstration should raise the suspicion of extrahepatic portal or splenic vein obstruction, which may be verified by angiography.

Coronary calcium measurements by double helical computed tomography. Using the average instead of peak density algorithm improves reproducibility.

RATIONALE AND OBJECTIVESnCoronary calcium (CC) measured by fast computed tomography (CT) was proposed recently as a noninvasive method of monitoring the coronary atherosclerotic process. Assessment of the reproducibility of CC measurements (mainly interstudy variability) is essential for consistent interpretation of serial studies.nnnMETHODSnThe authors scanned 74 patients (50 men and 24 women) twice on the same day to determine the interstudy variability of a new scoring algorithm, using the average instead of conventional peak CT density values.nnnRESULTSnNineteen patients had no calcium on either scan. In the remaining 55 patients, interstudy variability was decreased by 31% using the average algorithm (32%-23%; P < 0.001).nnnCONCLUSIONSnUsing the average instead of conventional peak density score provides better reproducible measurements of calcium by double helical CT.

Splenic Vein Thrombosis in Patients With a Normal Size Spleen

The frequency of splenic vein obstruction secondary to pancreatic or retroperitoneal diseases has been only recently appreciated. The diagnosis is important because it frequently results in development of gastric and duodenal varices. It is often assumed that the diagnosis should only be suspected in patients with splenomegaly. This report describes 19 patients in whom splenic vein thrombosis was diagnosed by angiography although clinically unsuspected. In 11, the spleen was normal in size although extensive gastric varices were present. In 3 patients the presenting problem was massive hematemesis. Review of the upper gastrointestinal examinations in these patients showed thickened gastric or duodenal folds although in the absence of esophageal varices, the diagnosis was not made prior to angiography. More liberal use of angiography in patients with an appropriate clinical background, such as a history of pancreatitis, may lead to earlier and more frequent diagnosis of splenic vein obstruction. Varices that result from splenic vein obstruction can be cured by splenectomy.

Double-helical CT as a new tool for tracking of allograft atherosclerosis in heart transplant recipients.

RATIONALE AND OBJECTIVESnTracking the progression of allograft atherosclerosis in heart transplant recipients is currently accomplished using invasive techniques. If its monitoring feasibility is demonstrated, spiral CT could be a non-invasive alternative for this objective.nnnMETHODSnTwenty-four consecutive heart transplant patients (21 men, 3 women, mean age 55 +/- 11 years) were scanned using double-helical CT. The first scan was performed 1.9 +/- 1.3 years after transplantation. After 2 years of follow-up, 4 patients died and the remaining 20 underwent a second scan. All scans were performed according to a previously reported double-helical CT protocol.nnnRESULTSnThe incidence of coronary calcification at the first scan was 4.2% (1/24); it increased to 40% (8/20) at the second scan (P < 0.001). Spiral CT identified new but very mild calcific deposits in seven patients with a mean total calcium score of 6.7 +/- 4.0.nnnCONCLUSIONSnDouble-helical CT is a viable tool to diagnose and track newly developed allograft atherosclerosis.

Magnetic resonance imaging of hydatid cyst in skeletal muscle

The typical MRI features of hydatid cyst in soft tissue/muscle are presented and discussed.

Renal capsular tumors: the angiographic features.

Five masses of the renal capsule, which were studied angiographically, demonstrated a typical inward displacement of the renal parenchyma, and prominence and variable displacement of the renal capsular arteries. Benign lesions typically lacked malignant neovascularity and had a sharp interface with the renal parenchyma. The angiographic characterization of renal capsular lesions may help in identification of benign lesions and prevent unnecessary nephrectomy.

Relationship of pressure and flow to arterial diameter

The effects of manipulations of blood pressure and flow on the diameter of the femoral artery in dogs were studied. Diameter measurements were made utilizing real time ultrasound scanning. Although diameter of a flexible tube in a mechanical system varies with internal pressure, in the intact femoral artery the diameter varied with changes in blood flow rate rather than pressure. Increase in blood flow rate resulted in increase in vessel diameter, whether the pressure changed or remained the same. Decrease in blood flow rate resulted in decrease in diameter, irrespective of the pressure. However, when a segment of the femoral artery was isolated from the femoral artery by interposition between plastic tubes, the diameter of the isolated segment no longer increased when flow increased. These findings suggest that arterial diameter is regulated by a conducting mechanism that depends on vascular continuity.

A Complication of Circumaortic Renal Vein Obstruction in an Obese Patient

AbstractAngiographically diagnosed obstruction of a left circumaortic renal vein in an obese man was the presumed cause of hematuria and proteinuria. The anatomy and potential complications of this anomaly are reviewed and discussed.

Angiographic diagnosis of intrinsic duodenal inflammatory disease.

Duodenal tumors are rare but duodenal inflammatory disease occurs frequently. In most cases it can be accurately diagnosed without angiography but in the occasional case that presents a diagnostic problem, angiography is required. Seven cases of duodenal inflammatory disease are reviewed. Careful attention to the shape and direction of vascular displacement and to separate evaluation of pancreatic and duodenal arteries accurately distinguished duodenal from pancreatic disease. This distinction can significantly influence subsequent therapy.

Targeted ultrasound is the procedure of choice for detecting rudimentary branchial cysts causing jugular and subclavian vein thrombosis

The aim of this study was to facilitate the imaging diagnosis of branchial cysts leading to combined jugular and subclavian vein thrombosis during ovarian hyperstimulation syndrome (OHSS). Three women developed combined jugular and subclavian vein thrombosis following OHSS related to assisted reproductive technologies. The imaging modalities used for diagnosis were a bimode Doppler ultrasound, MRI of the neck in two women, computed tomography (CT) angiography and venography in one. Targeted ultrasound identified the rudimentary cysts in all patients, whereas CT angiography performed with contrast material failed to detect the cyst, which resembled a vessel with thrombus in the lumen. MRI performed at the same level did detect the cyst; however, MRI of the neck requires special attention using a dedicated cystic protocol at the base of the neck. Venography was performed in one patient; it demonstrated the thrombosed vein possibly with some extrinsic compression, but it could not define a cyst. Targeted ultrasound is the simplest and best imaging modality for discerning rudimentary cysts in pregnant women with OHSS who present with jugular and subclavian vein thrombosis following assisted reproductive technology. A search for the cyst at the time of OHSS is important, as early detection could decrease the risk of developing thrombosis.