Angiodysplasia as a source of intestinal bleeding.

Nine cases of angiodysplasia have been angiographically identified in the past eight years at the two teaching and two major private hospitals in the West Los Angeles-Santa Monica area. In seven patients, repeated massive hematochezia whose source had escaped previous intensive diagnostic studies, was the indication for angiography. Two malformations were found incidentally during an angiogram for an unrelated problem. Four of the patients had had a previous angiogram which failed to show the lesion. Eight of the nine patients had right colon vascular malformations, but one had jejunal angiodysplasia as well. One patient had a midileal vascular malformation which appeared in the right lower quadrant on the study. Six of the seven underwent resection of the implicated bowel, and none have rebled. The series suggests that angiodysplasia may not be as rare as commonly assumed and in four cases escaped detection even angiographically at least initially. The lesions may be multiple and their anatomical site radiologically deceptive. Finally, these vascular malformations may be an incidental finding, and though demonstrable angiographically, may not necessarily be responsible for bleeding in the patient older than fifty years.

Nuclear imaging, tomographic nuclear imaging, and gray scale ultrasound in the evaluation of the porta hepatis.

Twenty-six patients with an eqivocal portal defect on conventional nuclear images were evaluated with a multiplane tomographic nuclear scanner and gray scale ultrasound. In most cases the correct determination (normal or abnormal) for an area of decreased uptake could be made from the multiplane tomographic scans. When an abnormality was thus confirmed, further characterization was provided by ultrasound.

Technique for transjugular placement of an umbrella filter in a left inferior vena cava.

Transjugular placement of a Mobin-Uddin umbrella fillter in an anomalous left inferior vena cava to prevent recurrent pulmonary embolization may present technical difficulties. Preforming a slight curve in the applicator wire a short distance from its tip allowed catheterization and proper position of a fillter in two cases.

105 mm photofluorography: an adjunct to the study of coronary arterial and vascular disease.

Obtaining high resolution static films through an image intensifier has been made possible by recent developments in radiographic equipment. Serial photofluorography 105 mm spot filming has been used successfully to complement cine coronary arteriography in approximately 700 patients. Many patients with coronary heart disease have diffuse peripheral atheromatous changes which are also suitable to study by serial 105 mm photofluorography. Aortic arch, abdominal aortography, and peripheral studies are easily and quickly performed in conjunction with coronary arteriography. Satisfactory results still depend upon skillful application by the angiographer of this imaging mode and proper processing of the film. Advantages of photofluorographic filming over conventional large film techniques include lower radiation exposure, reduction of costs, and easier film handling and storage. Most important is the facilitation of the performance of angiographic studies since constant television monitoring of the catheter and the contrast injections is possible. Disadvantages include restricted area of coverage and slight decrease in resolution. Our experience indicates that photofluorography may be relied upon in the study of vascular disease eliminating the need for large film changers in a laboratory used primarily for cardiac diagnosis.