Crohn's disease in black patients.

Crohn's disease is less prevalent in blacks than in whites. However, when it does occur, it is associated with a high degree of morbidity and is frequently unrecognized at initial presentation. Forty-three patients with Crohn's disease presented to Howard University Hospital between 1965 and 1987. There were 156 hospital admissions, 47 emergency room visits, and 76 clinic visits over this 22-year period. Twenty-eight patients were female and 15 were male. The age of presentation for males ranged from 18 to 63 years and for females, 12 to 74 years. Crohn's disease should be considered in black patients who present with chronic abdominal pain and diarrhea. With correct diagnosis and appropriate medical therapy, patients should have an enhanced quality of life with less morbidity.

Computed tomography of thorotrastosis.

Two cases of thorotrastosis examined by computed tomography are reported. The appearance of the liver, spleen, and lymph nodes is diagnostic. This technique is probably the procedure of choice for detection of Thorotrast-induced liver neoplasm.

Computed tomography of xanthogranulomatous pyelonephritis presenting as a flank mass.

Xanthogranulomatous pyelonephritis should be part of the differential diagnosis when extensive soft tissue involvement is associated with renal disease. As a diagnosis of neoplasm may be rendered even on microscopy, it is particularly important that this entity be considered.

Hypoplasia of the odontoid with atlanto-axial subluxation in Hurler's syndrome.

There appears to be an increased incidence of hypoplasia of the odontoid in Hurler's syndrome. As this predisposes to atlanto-axial subluxation, it should be sought in this mucopolysaccharidosis, as well as in Morquio's syndrome.

Fecal fistula following appendectomy in Crohn's disease.

Postappendectomy fecal fistula formation in a young patient should suggest the possibility of Crohn's disease. The diagnosis can often be established by injection of water-soluble contrast into the fistula.

Arterial impressions on the stomach.

The splenic artery frequently produces a contour defect on the posteromedial aspect of the stomach, particularly in elderly individuals. When the artery is tortuous or aneurysmal, the impression is prominent and may simulate a neoplasm. Similarly, the aorta can produce a gastric impression. Recognition of these impressions on the stomach wall avoids erroneous diagnosis and unnecessary exploratory surgery.

Duodenum inversum.

Duodenum inversum is usually associated with chronic abdominal pain which is of unknown etiology. Incomplete rotation of the bowel may be associated with this anomaly. An unusually high incidence of pancreatitis, elevated bilirubin, and hypoalbuminemia was noted in this series of nine patients.

Simplified double contrast examination of the esophagus.

A modification of the "straw technic" of Amplatz(1) (used in examination of the stomach and duodenum) is employed as an inexpensive, rapid, and simple method for double contrast examination of the duodenum.

Radiologic appearance of the Collis-Belsey fundoplication.

The Collis-Belsey hiatal hernia repair is distinctive radiographically. Knowledge of the operative technique allows more meaningful evaluation of the postoperative appearance of the gastroesophageal region.

High pressure injection injury of the hand.

Attention is called to the importance of prompt and adequate treatment of high pressure injection injury of the hand.

Fecaloma simulating colonic neoplasm.

Large, discrete fecal masses in the colon may be confused with neoplasms, particularly if they are relatively immobile. The radiologic features of such masses generally permit their true identification.