Roentgenologic Appearance Research Articles

Urethral meatal stenosis in female children simulating bladder-neck obstruction

In some instances, distal urethral stenosis in female children may be associated withthe roentgenologic appearance of a prominent, collarlike vesical neck, as a reflection of generalized detrusor hypertrophy. This ring has often been confused with bladder-neck obstruction. Clinical response to urethral dilatation and subsequent regression of abnormal roentgenologic findings confirms the importance of distal urethral stenosis as a cause of bladder-neck hypertrophy.

Behavior of anterior basal cerebral structures in midline tumors of that region.

BEHAVIOR OF ANTERIOR BASAL CEREBRAL STRUCTURES IN MIDLINE TUMORS OF THAT REGIONPETER BLADIN, M.D. and HERBERT SCHUNK, M.D.Audio Available | Share

HYPERPLASIA OF BRUNNER'S GLANDS.

Hyperplasia of the duodenal glands of Brunner was first described by pathologic anatomists in 1876 and introduced as a radiologic entity by Erb and Johnson (2) in 1948. In 1934 Feyrter (3) classified hyperplasia of Brunner's glands into three types. The first is diffuse nodular hyperplasia consisting of coarse mucosal folds and irregularly circumscribed nodules composed of duodenal glands which are distributed throughout the greater portion of the duodenum. The second type is the circumscribed nodular hyperplasia in which isolated nodules of Brunner's glands are located in the suprapapillary portion of the duodenum, often accompanied by atrophy of the intervening glands. The third type is the single nodule of adenomatous hyperplasia varying in size up to several centimeters. The solitary nodule is usually located in the duodenal bulb and may be either sessile or pedunculated. Robertson (6) did extensive investigative work on the duodenum and concurred with Feyrter's classification although he used the term hypertrophy rather than hyperplasia to designate the changes. The purpose of this report is to describe the roentgenologic appearance of hyperplasia of Brunner's glands as encountered and proved in 2 patients. Case Reports Case I:A 77-year-old, Negro female was admitted to Michael Reese Hospital with the chief complaint of left lower abdominal pain of one month duration. The pain occurred intermittently with no apparent relation to food intake. On two occasions during the week prior to admission the patient noted black stools. In recent months generalized weakness and a weight loss of 12 pounds had occurred. Physical examination was unremarkable except for a palpably enlarged liver and minimal tenderness in the left lower quadrant of the abdomen. Significant laboratory findings were as follows: hemoglobin: 8.6 g per 100 ml; hematocrit: 25 per cent; guaiac-positive stools; total protein: 5.9 g per 100 ml with albumin/globulin ratio of 2.2/3.7; and a tetracycline fluorescence test suspicious but not positive for gastric carcinoma. Liver function tests were reported as normal, as was a barium enema study. An upper gastrointestinal roentgen examination revealed irregularity and rigidity of the body of the stomach with an intraluminal ulcer crater just above the incisura. A large round filling defect was demonstrated in the duodenal bulb (Fig. 1). At surgery a round ulcerated tumor measuring 8 × 8 cm. was found in the body of the stomach, arising from the posterior wall and extending over the greater curvature for a distance of 1 cm. Projecting from the mucosa of the duodenum at a point 1 cm from the pyloric sphincter was an ovoid nodule measuring 3.5 × 3 × 2.5 cm, completely covered with a slightly hyperemic smooth mucosa (Fig. 2). A subtotal gastric resection with a Billroth-I procedure was performed.

Diffuse skeletal hemangiomatosis: Report of two cases and review of literature

Two cases of diffuse skeletal hemangiomatosis are presented, one benign, with unusual pulmonary involvement, and one malignant. The literature on skeletal hemangiomas is reviewed, particularly with reference to the previously recorded twenty-four cases of diffuse skeletal hemangiomatosis. The relation to other syndromes is discussed. The association with visceral involvement is emphasized as the main determinant of a serious prognosis. Hemangiomatosis restricted to the skeleton, despite its diffuse osteolytic and blastic roentgenologic appearance, is basically a benign condition. Treatment is briefly discussed.

Pulmonary Edema by Ascending to High Altitudes

Acute pulmonary edema was observed in 36 young healthy persons after ascending to altitudes 13,700 feet or more above sea level. Most of them were born and living permanently at high altitudes and developed pulmonary edema on returning to the mountains after a relatively short stay at lower or sea levels. The clinical manifestations were usually severe and rapidly progressive disappearing in 24 to 48 hours with oxygen administration. The predominant roentgenologic appearance was a coarse mottling exudate, more confluent in both parahilar regions. The heart size remained normal. The electrocardiogram showed acute right ventricular overloading and primary disturbances of repolarization probably related to right ventricular myocardial ischemia. Cardiac catheterization performed in one patient during the recovery period at sea level, revealed normal pressures in the pulmonary artery and capillary bed. Necropsies performed in two patients showed severe pulmonary edema, extensive areas with hyaline membrane, thrombosis of distal arteries and septal capillaries and multiple preterminal arterioles. The left atrium and ventricle were normal and there was a moderate right ventricular hypertrophy usually found in the high altitude resident. Pulmonary edema of high altitude appears to be the result of a magnification of the hemodynamic changes occurring during a rapid exposure to an environment of hypoxia and low temperature. These changes would be an increase in cardiac output and pulmonary blood volume, pulmonary vasoconstriction at pre-capillary level with secondary pulmonary hypertension, and increased pulmonary capillary permeability.

Lipomas of the colon: The importance of accurate diagnosis in preventing unnecessary radical surgery

1. 1. Lipoma is the second most common benign tumor of the colon, and pain is its most constant symptom. 2. 2. The characteristic roentgenologic appearance of a lipoma of the large bowel is that of a radiolucent intramural lesion with smooth margins and a broad base. It may be large, lobulated, compressible and act as the lead point of intussusception of the colon in adults. 3. 3. This tumor is frequently difficult to locate at surgery because it is soft and compressible. 4. 4. Huge dilatations of the ileocecal valve may result from lipomas arising in the region of the cecum. 5. 5. Failure to recognize the benign nature of the lesion resulted in an unnecessary wide resection of the colon in one patient. 6. 6. Familiarity by both the surgeon and radiologist with lipomas of the colon and its suggested preoperative diagnosis will reduce the number of unnecessary radical bowel resections.

Primary Sarcoma of the Lung

SUMMARY 1.Ten cases of primary sarcoma of the lung have been described and a brief review of the literature presented. 2.The clinical picture and roentgenologic appearance of the lesion are not characteristic and the diagnosis must be made by histologic examination of tissue obtained by bronchoscopy or thoracotomy. 3.Surgical excision is the only effective method of therapy.

Benign tumors of the duodenum.

CRUVEILHIER REPORTED the first case of a benign tumor involving the duodenum in 1835. This was regarded as an unique medical curiosity until Rokitansky, in 1861, reviewed several cases from his extensive postmortem dissections and wrote a treatise describing the basic pathology and clinical symptoms. Since that time, numerous case reports of benign duodenal lesions have appeared in the literature. In a monumental piece of work River, Silverstein and Tope reviewed 1,399 benign small intestinal tumors reported in the literature. Their study included 211 benign duodenal tumors. Within a recent 4-week period, 3 patients were admitted to our hospital for surgical excision of benign duodenal lesions. A subsequent review of the hospital case records for the past eight years disclosed an additional 4 operated cases and 8 nonoperated cases. In the 8 nonoperated cases the diagnosis was made by the characteristic roentgenologic appearance and confirmed by a follow-up of 3

Studies on Roentgenologic Appearance in Pulmonary Hypertension : Relationship between the Appearance of Pulmonary Vasculature on the Roenrgenologic Chest Film and Pulmonary Hemodynamics

Studies on Roentgenologic Appearance in Pulmonary Hypertension : Relationship between the Appearance of Pulmonary Vasculature on the Roenrgenologic Chest Film and Pulmonary Hemodynamics

Corrected transposition of the great vessels Report of 2 cases

Two cases of corrected transposition of the great vessels have been reported: one with an associated “mitral incompetence” and a complete atrioventricular block, and one with mild pulmonary stenosis and Grade I atrioventricular block. In both cases, proper evaluation of the physical findings, ECG, and roentgenologic appearance enabled us to reach the diagnosis which was confirmed by heart catheterization.

The roentgen appearance of gastric argentaffinoma.

The purpose of the study to be reported here was to determine the roentgenologic appearance of argentaffinoma of the stomach and to report 4 cases of this rare tumor, 3 primary in the stomach and 1 with metastases involving that organ. Bensaid (3) states that gastric argentaffinomas represent only 1 per cent of all carcinoids. Lattes and Grossi (24) found records of only 5 carcinoids of the stomach in the Presbyterian Hospital files from 1910 to 1955. During that time 1,236 carcinomas of the stomach were encountered. To our knowledge there are now 59 published cases of gastric argentaffinoma (5, 6, 8, 12, 16, 20, 24, 29). Argentaffinomas originate from the Kulschitzky cells of the crypts of Lieberkuhn, as demonstrated by Gosset and Masson (19) and Masson (33), who considered these tumors to be of endocrine origin because of the resemblance to the chromaffin cells of the paraganglia. Carcinoids appear almost exclusively below the esophagus in the gastrointestinal tract, particularly in the region of the ap...

Disseminated indeterminate pulmonary disease; value of lung biopsy.

Forty or fifty years ago the roentgenologic picture of disseminated pulmonary disease usually was thought to mean tuberculosis. Since that time many other causes have been recognized, and an awareness of the wide variety of conditions which produce this picture has grown rapidly in the past quarter of a century. In 1938, for example, King (1) catalogued 10 possible causes, in 1942 Austrian and Brown (2) enumerated 22, in 1948 Felson and Heublein (3) counted 75, and by 1952 Scadding (4) had raised the figure to 80. For purposes of classification the numerous conditions may be subdivided into seven groups: infections, inhalations, aspirations, vascular diseases, systemic diseases and pulmonary diseases of uncertain etiology, neoplasms, and allergies. With the growing recognition of the many entities producing a roentgenologic appearance of disseminated pulmonary disease has come the realization that the information gained from the clinical history, the physical examination, and the routinely available laboratory procedures is often insufficient to provide a definite diagnosis. Surgical procedures designed to obtain tissue for histologic, bacteriologic, and chemical examination have been employed, including bronchoscopic biopsy, biopsy of the scalene group of lymph nodes, and direct biopsy of the lung. Biopsy of the lung is seldom used unless all other means have failed to provide a diagnosis. Pulmonary tissue may be obtained in several ways; for example, by needle biopsy, by the limited biopsy procedure described by Klassen (5), and by means of formal thoracotomy. Needle biopsy is hazardous, sometimes causing hemorrhage or pneumothorax, and frequently it fails to furnish sufficient material for adequate examination (6). The limited biopsy of Klassen, employing a small intercostal incision, usually in the third or fourth interspace anteriorly on the right, provides an adequate specimen and accessibility to all portions of the right lung. Formal thoracotomy has the added advantage of allowing gross inspection of the entire lung, thereby insuring that tissue will be obtained from the most advantageous site. In a limited number of cases, therefore, biopsy of the lung provides a definite diagnosis which is useful in planning treatment, in determining prognosis, and in solving the medicolegal problems of patients subjected to occupational hazards. At the Mayo Clinic, from Jan. 1, 1950, to Dec. 31, 1955, biopsy of the lungs was employed in 34 cases of disseminated pulmonary disease. In each instance the results of other methods of diagnosis had been inconclusive, including 17 cases in which exploration of the scalene group of lymph nodes had given negative results. In all 34 cases tissue was obtained by formal thoracotomy.

Cavernous hemangioma of the gastrointestinal tract; report of a case and review.

cavernous hemangioma of the gastrointestinal tract is a rare lesion. Though it is frequently fatal, it is practically always curable. Its preoperative recognition is therefore of importance. Fortunately, many of these lesions present a recognizable roentgenologic appearance. Phleboliths have been reported in cavernous hemangioma of the stomach and colon and, when present, are highly suggestive of the diagnosis. Hansen, in 1948, wrote: “Phleboliths are said to be common and are often an important diagnostic point [in diffuse infiltrating cavernous hemangioma of the small bowel] but in no reported case of this type has the presence of phleboliths been mentioned.” Ochsner and Penick have also commented on this omission as recently as 1957. It is felt worthwhile, therefore, to report a case of jejunal hemangioma exhibiting numerous phleboliths in preoperative roentgen studies. The most widely accepted classification of gastrointestinal hemangiomas is that of Kaijser, as follows: I. Multiple phlebectasia II. ...

Primary reticulum cell sarcoma of bone

I N this paper an additiona case of primary reticulum cei1 sarcoma of bone shall be presented and the current status of this ciiscase ciiscussed from the diagnostic, pathologic and therapeutic standpoint. The value of arteriography as an important diagnostic aid will also be emphasized. The possibility that primary reticulum ceI1 sarcoma of bone wouId originate directly from reticuIoenciotheIia1 elements of the bony structures was suggested by 0i~erIing.“~2x Following the work of Parker and Jackson,2$ this type of sarcoma was established as a distinct entit\from the clinical nnci histopathoiogic point Jf viebv. Their opinion was supported by Edwards.‘” Sherman anti Snycier”j ciescribeti in great detail the roentgenologic appearance of primary reticulum cell sarcoma of bone seven years later. Additional reports by CoIe,~v and co-workers,“,6 h,lcCormack et al.,‘4 and Ivins and Dahlin’j represented contributions of great vaIue toward the cIarification of the diagnostic, histopathologic and therapeutic aspect of this often inadequately Iabeied malignant process. The rather restricted number of cases reported even as the result of extensive studies of pathologic material avaiIabIe15x24*“3 over a period of a quarter of a century or more indicates that this type of bone tumor is uncommon. A critical revielv of the avaiIabIe \~orId literature ?-ieIded, in the light of the criteria mentioned Iater, a total of 151 cases of primary reticuIum ceI1 sarcoma of bone, seven of Lvhich have to be considered atypical.

The effect of cholecystostomy upon subsequent roentgenologic appearance of the gallbladder.

Thirty-Five, twenty-five, and even twenty years ago a considerable number of physicians and surgeons regarded cholecystostomy as preferable to cholecystectomy for chronic disease of the gallbladder. Inasmuch as present criteria for either operation differ considerably from those held previously (due to the availability of antibiotics and the development of improved anesthetic and operative procedures, as well as the fact that patients now avail themselves of medical care earlier), it is believed that there will be few opportunities in the future to study any appreciable number of patients in whom cholecystostomy has been followed, after a significant period of time, by cholecystography. Material And Methods This study presents the results of cholecystography in a series of 38 patients who had previously undergone cholecystostomy. In almost all instances, the operation had been performed originally for acute cholecystitis or empyema of the gallbladder. In none of these cases was it done as an elective or i...

Primary reticulum-cell sarcoma of bone, with emphasis on roentgen aspects.

Primary reticulum-cell sarcoma of bone is a malignant tumor histologically indistinguishable from reticulum-cell sarcoma arising in other regions of the body. It originates at a single site in bone and, when metastasis occurs, it is usually by way of the lymphatics. Pain and swelling are the chief symptoms, and characteristically there is lack of constitutional reaction. The prognosis is relatively good, the five-year survival rate approaching 50 per cent following operation or proper irradiation. The importance of distinguishing between this tumor and other similar, but more malignant, conditions, such as osteogenic sarcoma and Ewing's tumor, is apparent. Several articles make mention of the roentgen findings in primary reticulum-cell sarcoma of bone, but the only paper in the English or American literature devoted specifically to evaluation of the roentgenologic appearance is that of Sherman and Snyder (1), whose study was based on a review of 17 cases. It seemed, therefore, that further study of this problem in as large a number of cases as possible would be of value. It was thought desirable to determine whether there are certain characteristic roentgen signs of this lesion and, if not, whether there are any suggestive findings. In the final analysis, it would be most important to know whether primary reticulum-cell sarcoma of bone can be recognized unmistakably as a malignant neoplasm and thus distinguished from a benign tumor or an inflammatory process. Background Data Oberling (2) in 1928 and Oberling and Raileanu (3) in 1932 were among the first to call attention to the fact that reticulum-cell sarcoma can develop in the reticulo-endothelial tissues of bone. Ewing (4), however, stated that, even prior to this, Kaufman had reported a case of what appears to have been primary reticulum-cell bone sarcoma. According to Parker and Jackson (5) the diagnosis was first suggested in this country in 1931 (Bone Sarcoma Registry No. 1059). Primary reticulum-cell sarcoma of bone was recognized as a distinct entity in 1939, when Ewing reviewed all the material from the Bone Sarcoma Registry of the American College of Surgeons and assigned it a place in his revised classification of bone tumors. Prior to 1939, it had been erroneously identified as Ewing's tumor, lympho-sarcoma, osteogenic sarcoma, Hodgkin's disease, leukosarcoma, or inflammatory changes. Parker and Jackson, also in 1939, reported the first series of primary reticulum-cell sarcoma of bone, consisting of 17 cases. They pointed out that, whereas generalized reticulum-cell sarcoma (a type of malignant lymphoma usually affecting the lymph nodes and spleen predominantly) is a disease of middle and old age, the form which is primary in bone occurs in a younger age group. In their only reference to the roentgen findings, they stated that the appearance was nonspecific. In 1940, Edwards (6) reported a case of primary reticulum-cell sarcoma of the spinal column.

The Roentgenologic Appearance of The Small Intestine in Sprue

The Roentgenologic Appearance of The Small Intestine in Sprue

The roentgenologic appearance of the aqueduct of Sylvius.

The roentgenologic appearance of the aqueduct of Sylvius.

A roentgen study of the effect of exclusion of pancreatic juice from the intestine on gastrointestinal motor activity in the dog.

In a previous study the effects of the loss of both intrinsic and extrinsic secretions of the pancreas upon the roentgenologic appearance of the gastrointestinal tract of dogs were evaluated (11). Hyperglycemia in the depancreatized animals was associated with a marked delay in gastrointestinal motility. During insulin-induced hypoglycemia, normal, and at times rapid, gastric emptying and small-intestinal transit times were noted. In these experiments it was not possible to ascribe any of the effects observed to a loss of the external secretion of the pancreas because, if any were present, they could have been masked by the influence of the abnormal blood sugar levels. In order to study this problem further, the roentgen procedures were repeated with non-diabetic dogs in which the external pancreatic secretion was prevented from entering the intestine by ligation of the pancreatic ducts. Material and Methods The gastrointestinal tracts of three young adult dogs were examined roentgeno-graphically by the method previously described (11). Subsequently the animals were subjected to laparotomy3 under intravenous Nembutal anesthesia. The pancreas and duodenal loop were exposed; the common duct and both pancreatic ducts were identified. The pancreatic ducts were ligated and the pancreas was separated from the duodenum throughout its length, its blood supply being left intact at each end. Omentum was interposed between the pancreas and the duo-denum. The denuded areas of the gland were thus covered in an attempt to provide a barrier to fistula formation between the pancreas and bowel. The abdomen was then closed. Following a one-week recovery period the roentgen examinations of the gastrointestinal tract were repeated. Throughout the experiment the dogs were maintained on a routine kennel diet. Immediately following the last roentgen examination each dog was again subjected to laparotomy under intravenous Nembutal anesthesia. The pylorus and the duodenum distal to the pancreas were ligated. From the distal end of the closed duodenal loop the content was aspirated and analyzed for pancreatic enzymes. The pylorus, duodenum, and pancreas were then removed, and the animal was exsanguinated. The roentgen appearance of the gastrointestinal tract was subjected to analysis, with special attention to gastric emptying time, tone, and motility, and to small-intestinal transit time, tone, and continuity of pattern. Results Stomach (Table I; Fig. 1): The median value for gastric emptying in the three of the transit time was 130 minutes, with extremes at 80 and 200 minutes. The small-intestinal transit time for individual dogs was also in the general range of those found preoperatively. Tone, as indicated by the width of the barium column, and its continuity, were unchanged following ligation of the ducts. Colon: The width of the proximal colon was measured, on first filling when possible.

The Roentgenologic Appearance of the Aqueduct of Sylvius

The Roentgenologic Appearance of the Aqueduct of Sylvius