Duplex sonography of the portal venous system: pitfalls and limitations.

Duplex pulsed-Doppler sonographic examinations of the portal venous systems of 14 patients were reviewed, and the results were compared with the findings of other examinations including endoscopy and angiography. The sonograms of virtually every patient in the sample showed at least one of four pitfalls. The "mirror-image" artifact, in which the Doppler signal contained simultaneous and symmetric elements on both sides of the zero baseline, was identified in 11 patients (79%). The "flip" artifact, in which the Doppler signal would either flip from one side of the zero baseline to the other or would indicate a direction of blood flow opposite to that normally expected, was seen in six patients (43%). In four patients (29%), a Doppler flow signal could not be obtained from small vessels that were identified on standard real-time images. In 10 patients (71%), important vascular channels including bleeding gastroesophageal varices were obscured by bowel gas, ascites, or the patient's body habitus. Duplex sonography may still provide useful information about portal venous hemodynamics. However, it remains a prodigious technical undertaking whose accuracy can be severely hampered by artifacts and inherent technical difficulties.

Routine CT screening of psychiatry inpatients.

During a 3-year period, all inpatients in the psychiatry unit underwent routine screening computed tomography (CT) in an effort to detect clinically unsuspected intracranial abnormalities. Of 261 patients examined who had no focal neurologic deficits, 103 had schizophrenia, 71 had depression, 48 had bipolar disorders, and 39 had paranoid delusions. Findings on 230 (88.1%) of the CT scans were within normal limits, and 27 (10.4%) showed only cortical atrophy. The remaining four cases (1.5%) demonstrated basal ganglia calcification (n = 2), old lacunar infarction (n = 1), or osteoma arising from the inner table of the skull (n = 1), all of which were considered to be clinically unrelated to the patients' psychiatric conditions. In the absence of focal neurologic deficits or other findings suggesting an intracranial abnormality (eg, papilledema, seizures, persistent or increasing headaches), there is no justification for routine CT scanning in patients admitted to the hospital for psychiatric disorders.

Ultrasound of polyorchidism: case report and literature review.

We report a case of polyorchidism that was suggested preoperatively by scrotal sonography. A review of the literature on this rare anomaly discloses a previously underemphasized association with malignancy.

Combined CT metrizamide syringography and needle aspiration of cystic intramedullary spinal cord lesions.

A modified spinal cord puncture technique that was combined with CT metrizamide syringography for the evaluation of potentially cystic spinal cord lesions has been used in 5 patients. This procedure proved to be safe and efficacious in the preoperative differentiation of cystic neoplasms from syringohydromyelia. It also aided in planning a surgical approach by revealing details of the tumor location and/or syrinx dynamics. Spinal cord puncture associated with CT metrizamide syringography has a role in the diagnosis and therapy of patients with cystic spinal cord lesions.

False aneurysm complicating orthognathic surgery.

A case of a pseudoaneurysm secondary to bleeding which occurred during an intraoral vertical osteotomy of the mandible is presented. The bleeding was thought to be controlled by packing, but ultimately a pseudoaneurysm formed. Arteriography was used to diagnose the lesion and embolization to treat it. Duplex ultrasound played a complimentary role in the diagnosis, and in monitoring the therapeutic course.

Mesenchymal hamartoma of the liver: computed tomography and ultrasonography.

Mesenchymal hamartoma of the liver is a relatively uncommon lesion that occurs with greatest frequency in infants and children. Two cases are presented, one as a predominantly cystic mass and the other as a predominantly solid mass.

Metrizamide shuntography for evaluation of shunt malfunction in hydrocephalus.

Ventricular shunts were evaluated by a shuntographic technique using metrizamide for the contrast material and delayed spot films and computed tomography (CT) to evaluate shunt function. Thirty hydrocephalic patients were studied who had clinical presentations of shunt malfunction. Fifty-two shuntograms were obtained; most demonstrated the cause of shunt malfunction. No contrast-related complications resulted from the procedure. Diagnostic accuracy was greatly improved by this method, since both anatomic and functional evaluations could be performed. In patients with normal studies, unnecessary surgery was eliminated; in abnormal shuntograms, the duration of surgery and the likelihood of complications were reduced because the surgeons knew the exact anatomic derangements to be corrected.

Calf hematoma mimicking thrombophlebitis: sonographic and computed tomographic appearance.

Five patients with calf hematomas presented with signs and symptoms suggesting thrombophlebitis, obscuring the correct diagnosis. Venography showed no venous thrombosis; further diagnostic studies using ultrasound and/or computed tomography provided the correct diagnosis in all patients. Ultrasound showed a hypoechoic mass clearly demarcated from surrounding soft tissue, while computed tomography showed a well-defined mass whose density depended on the age of the hematoma.

Sonographic findings in leiomyoma of postorchiectomy scrotum.

Leiomyomas of the scrotum are unusual testicular masses and a case report reviewing the ultrasonographic findings of this entity comprises this report. The ultrasonographic characteristics of leiomyoma have not been reported previously. The purpose of this case report is to discuss the findings of ultrasound in evaluation of leiomyoma in the area of the scrotum.

Thin spinal or biopsy needle guidance.

The thin needles that are used for myelography or biopsy are easily deflected in the body. We describe a simple method used to guide the tip of these needles to the target area using needle-hub rotation. This procedure was successfully used in more than 260 direct C1-C2 punctures for cervical myelography.

Trauma of occult hydronephrotic kidney.

The occult unilateral hydronephrotic kidney is often discovered during the genitourinary evaluation of patients sustaining blunt abdominal trauma. Few cases have been reported documenting the angiographic, computerized tomography (CT), and ultrasound appearances. Two cases are described which demonstrate that relatively minor trauma can precipitate hematuria and hypovolemic shock. Angiography demonstrated the bleeding site in both cases and was utilized in conjunction with other parameters of clinical assessment to plan initial management. CT and ultrasound proved to be useful noninvasive diagnostic parameters for baseline and follow-up studies in patients undergoing conservative management. They accurately demonstrated the degree of hydronephrosis, residual renal parenchymal, and resolving hematoma.

Computed tomography of internal jugular vein thrombosis.

Thrombosis of the internal jugular vein was diagnosed by computed tomography in two cases. On contrast computed tomography, the thrombosed vein appeared as an enlarged vein containing a low density lumen surrounded by a sharply defined wall. This entity should be looked for whenever a patient is examined by computed tomography for acute cervical swelling or inflammatory ear disease.

Adrenal insufficiency due to metastatic lung carcinoma and shown by abdominal CT scan.

Our patient's symptoms of adrenal insufficiency were the first evidence of recurrence of the primary tumor. The diagnosis of hypoadrenalism was established by the standard ACTH stimulation test. The elevated ACTH level provided corroborating evidence that this was primary adrenal insufficiency rather than secondary to hypothalamic-pituitary dysfunction. The CT scan of the abdomen then revealed bilateral adrenal gland enlargement as well as a less dense area in the spleen, both suggestive of metastatic disease. The CT scan has proven to be of value in diagnosing tumor involvement of the adrenal glands. The patient's response to hormonal replacement was both rapid and gratifying, and he was able to leave the hospital to resume his usual activities. The possibility of adrenal insufficiency should be considered in any patient with a history of carcinoma who has malaise, weakness, and weight loss. Adrenal insufficiency is a treatable condition, and treatment of it provides symptomatic relief that may increase the quality of life. As patients with cancer survive longer, this complication may be observed more frequently.

Membranous obstruction of the inferior vena cava: an ultrasound, computed tomography, and inferior vena cavogram image correlation.

The purpose of this paper is to present the computed tomography (CT) and ultrasound findings in one case of membranous obstruction of the inferior vena cava (IVC). Although the incidence of membranous obstruction of the IVC is rare in the United States, the diagnosis is essential because of the association of this lesion with portal fibrosis and hepatocellular carcinoma. Membranous obstruction of the IVC is suggested by the findings of a filling defect within the IVC at the level of either the diaphragm or right atrium. Until more specific CT and ultrasound features are described, an inferior vena cavogram will remain the definitive diagnostic procedure for membranous obstruction of the IVC.