ABSTRACT
Biopsy directed by needle localization is a safe and relatively simple method of obtaining abnormal tissue for histologic examination without sacrificing surrounding normal breast tissue. In the setting of a training institution, accurate results can be expected as technical skills are obtained by a variety of housestaff. In this series of 70 biopsies, the lesion targeted on mammography was removed on the initial attempt in all but 1 instance, for an overall accuracy of 99 percent.
Subject(s)
Breast Neoplasms/pathology , Internship and Residency , Adenofibroma/diagnostic imaging , Adult , Aged , Biopsy, Needle/methods , Breast Neoplasms/diagnostic imaging , Calcinosis/diagnostic imaging , Diagnosis, Differential , Female , Fibrocystic Breast Disease/diagnostic imaging , Humans , Mammography , Middle Aged , PalpationABSTRACT
The clinical course of 19 patients with pancreatic phlegmon, as diagnosed by computed tomography (CT) and clinical criteria, was assessed retrospectively and compared to that of eight patients with pancreatic abscess diagnosed either at surgery or with percutaneous aspiration. Controls consisted of 55 patients with uncomplicated acute pancreatitis without CT scans and 11 patients with acute pancreatitis in whom CT scans were negative or only consistent with acute pancreatitis (no phlegmon). The age, sex, and presumed etiology of the pancreatitis were not significantly different in the four groups. Patients with phlegmon had a higher incidence of severe pancreatitis as defined by Ranson's criteria, presence of an abdominal mass, as well as a longer duration of fever, abdominal pain and leukocytosis than controls without CT scans. With the exception of a palpable abdominal mass and fever lasting over five days, the results were similar when comparing the phlegmon group and controls with CT scans, although the severity of the disease and prolonged abdominal pain tended to be increased in the former patients. There was no statistically significant difference in clinical or laboratory criteria between the phlegmon and abscess groups, although the latter group had longer hospital stays and periods with no oral intake (npo). Management of patients with phlegmon tended to include TPN, longer npo periods, antibiotics, and longer hospital stay than in controls without CT scans. Controls with CT scans were managed similarly to the phlegmon group because of prolonged amylase elevation and abdominal pain. Percutaneous aspiration was successful in differentiating abscess from phlegmon in five of six cases. Major complications were rare in the phlegmon group and spontaneous resolution was the rule. Pancreatic phlegmon is a distinct clinical/radiologic entity which may be very difficult to differentiate clinically from pancreatic abscess. Early percutaneous thin-needle aspiration of the inflammatory mass (under CT guidance) seems to be the diagnostic procedure of choice. Management is nonsurgical unless complications arise. The role of TPN and antibiotics is unknown, and controlled studies of these therapeutic approaches in pancreatic phlegmon are needed.
Subject(s)
Cellulitis/diagnosis , Pancreatic Diseases/diagnosis , Abscess/complications , Abscess/diagnosis , Acute Disease , Adult , Cellulitis/etiology , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Pancreas/diagnostic imaging , Pancreatic Diseases/etiology , Pancreatitis/complications , Pancreatitis/diagnosis , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Two diabetic patients in whom emphysematous pyelonephritis developed after renal transplantation are described. Clinical recognition of this unusual and serious infection is masked by the effects of immunosuppression. Abdominal radiographic, ultrasound, and computed tomography findings are discussed. The clinical presentation includes urinary tract infection, sepsis, and acute tubular malfunction of the allograft in insulin-dependent diabetics.
Subject(s)
Emphysema/diagnosis , Kidney Transplantation , Pyelonephritis/diagnosis , Adult , Diabetes Mellitus, Type 1/complications , Diabetic Nephropathies/therapy , Emphysema/diagnostic imaging , Female , Humans , Male , Pyelonephritis/diagnostic imaging , Tomography, X-Ray Computed , UltrasonographyABSTRACT
The CT appearance of focal and diffuse fatty infiltration of the liver has been described in recent radiologic literature. Previous reports of focal steatosis have emphasized the differential diagnosis of the solitary lesion. We report a case of multifocal hepatic involvement and describe a new radiologic sign that is useful in differentiating this process from neoplasia.
Subject(s)
Fatty Liver/diagnostic imaging , Tomography, X-Ray Computed , Aged , Diagnosis, Differential , Fatty Liver/metabolism , Female , Histocytochemistry , Humans , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/secondary , Triglycerides/metabolismABSTRACT
We analyzed six cases of triplane fracture of the ankle and reviewed the literature. A previously undescribed fracture pattern was identified in one patient. CT studies proved to be useful diagnostic tools in the evaluation of triplane fractures when operative reduction was contemplated.
Subject(s)
Tibial Fractures/diagnostic imaging , Adolescent , Child , Epiphyses/diagnostic imaging , Epiphyses/injuries , Female , Humans , Male , Tibial Fractures/pathology , Tomography, X-Ray ComputedSubject(s)
Ascites/etiology , Heart Failure/etiology , Hemochromatosis/diagnostic imaging , Arthritis/diagnostic imaging , Ascites/complications , Diabetes Complications , Heart Failure/complications , Hemochromatosis/complications , Humans , Liver Diseases/diagnostic imaging , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
A case of a Jefferson fracture is presented. A new diagnostic sign, which is viewed on a lateral radiograph and consists of interposition of the basion between the anterior arch of C-1 and the odontoid process, is described. This sign may aid in the rapid identification of Jefferson fractures.
