Complications from extravasated retroperitoneal barium: case report and review of the literature.

Extravasation of barium into the retroperitoneum is an uncommon complication of radiologic examinations of the gastrointestinal tract. It may occur during evaluation of either the upper or lower tract. A case is presented in which the result was abscess formation, a potential delayed complication of duodenal perforation and retroperitoneal extravasation of barium. In this case, medical treatment was successful.

Technetium-99m hysterosalpingography in infertility: an accurate alternative to contrast hysterosalpingography.

Thirteen infertile women who had undergone tubal surgery within the previous year for the correction of tubal obstruction, were studied with both conventional and radionuclide hysterosalpingography. The studies were performed on the same day, were interpreted independently, and the results were then compared. Three cases were excluded from analysis because of the technical inadequacy of one of the studies. Assuming the findings of the conventional studies to represent "truth," the sensitivity, specificity and accuracy of the radionuclide studies were 100%, 60% and 80% respectively.

Mammography and breast implants.

Recent recommendations by the American Cancer Society have focused attention on the value of screening mammography in the detection of occult breast cancers. This has resulted in a proliferation of "walk in" and mobile mammography screening clinics and a barrage of publicity aimed at women aged 40 and over. Among these are more than a half million women who have had an augmentation mammaplasty; at least another half million are still under 40 but entering this age group incrementally. Opinion is divided as to the value of this procedure because of uncertainty as to the amount of breast tissue obscured by the implant. Calibrated planimetry was used to measure the area of the implant and the glandular portion of the breasts in six sets of mammograms. Utilizing solid geometric calculations, it was found that the percentage of glandular tissue obscured by the implant varied from 22 to 83 percent. This wide variation casts serious doubt on the reliability of routine film screen mammography in these patients.

Duodenal perforation during intubation for small bowel enema study.

Use of the small bowel enema examination (enteroclysis) is increasing, and numerous reports have attested to its value, but virtually no complications have been reported. The author describes a 72-year-old man undergoing enteroclysis for weakness, anemia, and guaiac-positive stools in whom the duodenum was perforated during intubation. Radiologists should be aware of this potential complication, and inexperienced people should be supervised carefully during the procedure.

The current evaluation of nonpalpable breast lesions.

To understand the suspected low yield of malignant neoplasms from biopsies guided by needle localization, we reviewed 122 biopsies performed from January 1985 to November 1986 at University Hospital and Arkansas Baptist Medical Center, Little Rock. The positive biopsy rates were 3.5% and 10.6%, respectively. After review of these cases, the following guidelines for biopsy were developed: (1) Do not perform a biopsy on a low-density mass less than 1 cm in diameter. (2) Do not perform a biopsy for asymmetric density or questionable mass. (3) Do not perform a biopsy for secondary signs of malignancy such as skin thickening or asymmetric vasculature. (4) Biopsy is indicated for clustered calcifications, a dominant mass greater than 1 cm in diameter, stellate lesions, or interval change from a previous mammogram. These changes resulted in a positive biopsy rate of 15% for the period from November 1986 through April 1987.

Early and delayed indium 111 leukocyte imaging in Crohn's disease.

Twenty-seven patients with Crohn's disease were studied for the presence and location of activity by both early (4 h) and delayed (18-24 h) indium 111 leukocyte imaging. The results were compared with other parameters of disease activity including Crohn's disease activity index, barium studies, and endoscopy. There was a correlation between early images and Crohn's disease activity index (r = 0.78) and between delayed images and index (r = 0.82). Based upon the corresponding Crohn's disease activity index, the sensitivity of early and delayed imaging was 81.0% and 95.2%, respectively. Specificity of early and delayed imaging was 75.0% and 87.0%, respectively. Presence of activity on the early and delayed imaging agreed with activity on barium studies and colonoscopy in approximately 80% of cases. Correlation of location of disease by leukocyte imaging and x-ray was observed in 58.9% of early scans and 55.0% of delayed scans. Correlation of the location of disease by imaging and endoscopy was observed in 71.4% of early and 75.0% of delayed studies. Because of the possibility of occurrence of false-negative results in early images, delayed imaging should always be included in evaluation of disease activity in patients with Crohn's disease who are suspected of having mild activity. Delayed imaging is not required if the early imaging study clearly shows activity.

Role of delayed indium-111 labeled leukocyte scan in the management of Crohn's disease.

Comparison of nine patients with Crohn's disease who had a positive delayed (24 hr) 111indium leukocyte scan and 10 patients with negative scan showed no significant difference between the two groups for the Crohn's disease activity index, sedimentation rate, survival, complications, number of days in hospital, outpatient visits, or readmissions. Despite the apparent lack of statistical significance in Crohn's disease activity index, the scan was positive in nine of 16 patients with a Crohn's disease activity index more than 150, and none of three patients with Crohn's disease activity index less than 150. In the patients studied, there were no false-positive leukocyte scans. In nine of 10 patients with ileocolonic disease, scanning results correctly predicted the proper management. Six patients with positive scan and enteroclysis responded to medical treatment. Four patients had positive enteroclysis and negative scan; of these, three had radiographic features of chronic ileal stricture which was confirmed at operation. The results suggest that a negative delayed indium-111 leukocyte scan may be useful in diagnosis of chronic fibrotic ileal stricture.

Randomized single-blind clinical trial of a rapid colonic lavage solution (Golytely) vs. standard preparation for barium enema and colonoscopy.

A randomized single-blind clinical trial was conducted to compare the effectiveness and acceptance by patients of a new oral balanced lavage solution with those of a standard preparation for cleansing the colon for barium enema (50 patients) and colonoscopy (20 patients). The quality of preparation was comparable for the 2 preparations. For colonoscopy, Golytely preparation resulted in slightly better results than standard preparation. Patient acceptance was comparable for the 2 preparations. We conclude that Golytely can be used as an alternative to standard preparation for barium enema. For colonoscopy, it is slightly superior to standard preparation.

Radiologic examination of the small intestine: review of 402 cases and discussion of indications and methods.

An analysis of the records of 300 patients who had had 370 small-bowel radiologic examinations and a subsequent 102 patients examined by fluoroscopy and enteroclysis suggests that enteroclysis (small-bowel enema) is extremely valuable in the radiologic evaluation of small intestinal disease. Our results suggest that best results are obtained if the radiologist spends adequate time to participate in and observe the studies carefully. We believe that the fluoroscopic observation of low-density barium passing through distended small bowel gives a much clearer picture of its status than routine follow-through examinations. Disagreement exists concerning the choice of Sellink's method, using dilute barium, and Herlinger's technique, using a somewhat denser barium followed by methylcellulose. We prefer the latter. Enteroclysis probably should not be done in the presence of a high small-bowel obstruction because of the danger of reflux and aspiration. If intubation is unsuccessful, an oral study should be postponed until the effects of the topical anesthesia disappear. A controlled prospective study of the accuracy of fluoroscopic enteroclysis versus a good detailed independent follow-through examination is needed.

Intraluminal pressure measurements during barium enema: full column vs. air contrast.

Intraluminal pressure measurements were made during enema examination of 10 patients undergoing full column studies and 10 patients receiving air-contrast studies. There was no significant difference between the pressure in the distal colon of the two groups. All pressures were less than those produced by Valsalva maneuver or straight leg raising, and were generally less than those previously found to be necessary to rupture the colon. The authors believe that the findings should dispel any fear that an air-contrast examination is more hazardous than a full column study. Perforations occurring during these procedures are more likely related to disease of the colon wall or local trauma.

The continent ileostomy (Kock pouch): roentgenologic features.

The principles of construction of a continent ileostomy by means of a reservoir as originally described by Kock are reviewed. Roentgenologic studies in 5 patients with such reservoirs are described. There may be a correlation of incontinence with peristaltic activity as well as nipple valve extrusion. The radiologic features are explained in terms of the anatomy of the reservoirs. One patient with postoperative ileitis is described. Roentgenologic studies may be of particular value to the surgeon in follow-up of these patients by demonstration of postoperative nipple valve extrusion and inflammatory changes in the pouch or remaining small intestine.