"Double fistula" bronchopleural and pleurocutaneous during radioxenon study.

A woman had a right pneumonectomy, complicated 5 years later by an anaerobic infection with a following "blowout" of the bronchial stump; an empyema developed. A muscle graft was used to close the bronchial stump. An Eloesser flap was created to allow drainage of the empyema. She was later admitted with respiratory distress. A ventilation lung scan was performed with Xe-133. This showed the results of a "double fistula," with passage of radioxenon into the right pleural space and then out of the body through the Eloesser flap.

Stereotactic needle biopsy of nonpalpable breast masses.

One hundred two patients with nonpalpable breast masses that presented as mammographic densities with or without calcification were studied consecutively. Using the Stereotix stereotactic device, fine-needle aspirations were obtained with subsequent hook-wire placement followed by surgical excision. Pathology results were reached separately and then compared to the cytologic diagnoses. For patients with adequate cytologic material, sensitivity was 95% and specificity was 100%. There were six suspicious or equivocal diagnoses: three were determined to be benign, while three were malignant. There was inadequate tissue in 13%. Although this technique had limitations, for patients with adequate cytologic and histologic material the accuracy was excellent.

Bone scans with one or two new abnormalities in cancer patients with no known metastases: frequency and serial scintigraphic behavior of benign and malignant lesions.

Scintigraphic, radiologic, and clinical follow-up findings were reviewed in cases in which bone scans (n = 301) showed one or two new abnormalities in patients with malignancy but no known metastases. Metastatic disease was confirmed for 25 of 231 scans (11%) with one new abnormality and for 17 of 70 scans (24%) with two new abnormalities. The prevalence of metastases was 0.06 to 0.13 for lesions in all regions of the skeleton, except the sternum (three of six) and the pelvis (10 of 32). On follow-up scans, in the absence of an interval change in therapy, 19 of 21 metastases became more intense, whereas most benign abnormalities either remained unchanged (47%) or resolved (41%). Benign lesions in the ribs, extremities, and pelvis generally resolved within 12-24 months, while most benign skull and spine abnormalities were still apparent after 35-58 months of follow-up.

Bone scans with one or two new abnormalities in cancer patients with no known metastases: reliability of interpretation of initial correlative radiographs.

To determine the reliability of radiographs obtained for correlation with bone scans showing one or two new abnormalities in cancer patients without known metastases, a retrospective study of 306 scans showing such lesions was performed. Overall, 14% of the lesions proved to be malignant. The initial radiographic interpretation was normal for 43% of the new bone scan lesions; 17% of these lesions were metastases. A benign process was identified on radiographs for 38% of the abnormalities; only one (1%) was a metastasis. Twelve percent of new bone scan lesions correlated with radiographic abnormalities considered either suggestive of or consistent with metastasis, of which 24% and 71%, respectively, proved to be metastases. In cancer patients with one or two new bone scan abnormalities, correlative radiographs showing a benign abnormality are reliable. However, if the radiographs are either normal or show findings considered suggestive of or consistent with metastasis, further evaluation or follow-up is warranted.

Sequential hepatobiliary scintigraphy demonstrating apparent transient biliary obstruction.

A case of acute acalculous cholecystitis in which sequential hepatobiliary scintigraphy demonstrated apparent transient biliary obstruction is presented. An initial technetium-99m diisopropyliminodiacetic acid ([99mTc]DISIDA) study in a patient suspected of acute cholecystitis showed persistent hepatic activity, nonvisualization of the gallbladder, and minimal intestinal activity seen only at 24 hr. Following a second injection of [99mTc]DISIDA administered shortly after the 24-hr image from the first study, the gallbladder and bowel were both visualized within 75 min. At subsequent surgery, acute and chronic cholecystitis were present without evidence of choledocholithiasis or other source of obstruction. Intrahepatic cholestasis following clearance of biliary obstruction may result in late bowel visualization on delayed cholescintigraphic images similar to that seen in partial obstruction. Accurate reflection of the state of hepatobiliary function may require reinjection with [99mTc]DISIDA.

Radionuclide imaging in a case of tertiary syphilis involving the liver and bones.

Tertiary syphilis is an unusual entity. We have encountered a case of tertiary syphilis of the liver and bone demonstrated by scintigraphy. With liver involvement, the liver scan showed focal defects due to gummas, and distortion due to scarring. Bone involvement was shown as increased cortical activity from periostitis, focal hot spots due to osteomyelitis, and cold defects due to gumma formation. Because syphilis is easily treated, but may not be as readily recognized, the diagnosis should be considered in cases of focal liver or bone disease of obscure etiology.