VALUE OF BIPLANE SPLENOPORTOGRAPHY.

Abstract

Splenoportography is a useful technic in the evaluation of a variety of diagnostic problems (1, 2). Our procedure differs basically in no significant way from that of Ruzicka and Rousselot's group (3). In view of the difficulty experienced in interpreting some of 100 splenoportograms in the anteroposterior views, however, biplane studies were added in the last 20 examinations (4). No attempt is made to analyze the entire series at this time; it is hoped that this preliminary report will show the additional value of the lateral projection with no increased patient risk. We have thus modified splenoportography by use of the biplane Schöonander apparatus. Films are loaded so that alternate exposures are obtained, avoiding any possibility of “fogging” from radiation scatter. The timing sequence based on an analysis of our total experience is as follows: One film alternating in each plane every second for ten seconds, followed by a four-second pause; two films obtained at one-second intervals followed by another pause of six seconds; four final films then made at the same speed. In all, sixteen films are obtained in each plane over a time interval of twenty-six seconds, beginning with the midinjection time of the opaque bolus. With 70 per cent sodium acetrizoate, our average injection time is ten seconds, and 30 c.c. of contrast material is used. When any question arises as to the location of the needle tip in relation to the splenic hilus, the image intensifier is employed, together with a trial injection of 5 c.c. of contrast material. This is less time-consuming than scout films and reduces the risk of needle displacement due to delay. Of the numerous biplane studies performed, the following have been selected as illustrative of the benefits to be derived. The anteroposterior films were interpreted before the lateral films were seen, so as to allow us to evaluate for ourselves any additional information gained. Case I: The first admittance of a 28-year-old Negro housewife to the Bronx Municipal Hospital Center was because of persistent nausea and vomiting of two weeks duration. Pertinent physical findings were scleral icterus and a liver palpable three fingerbreadths below the right costal margin. Serum electrolytes were consistent with a history of protracted vomiting, and liver function tests were suggestive of biliary obstruction. The upper gastrointestinal series showed a markedly dilated stomach with normal passage of barium through the pylorus into the duodenal bulb. An obstruction to the passage of barium was noted in the second portion of the duodenum, and a large extrinsic pressure defect, which appeared to be due to a markedly dilated common bile duct, was seen. Transhepatic cholangiography demonstrated dilatation of the common bile duct, with complete distal obstruction, and a normal gallbladder.