The northern exposure sign: a newly described finding in sigmoid volvulus.

OBJECTIVE: Previous studies of sigmoid volvulus have focused on the migration and dilatation of the sigmoid with respect to both fixed and mobile landmarks in the abdomen. None has specifically referred to the relationship of this colonic segment to the more proximal large intestine. We analyzed findings on abdominal radiographs, all of which had been obtained with the patient supine, of sigmoid volvulus, with particular attention to the juxtaposition of the sigmoid colon with the transverse colon. MATERIALS AND METHODS: The abdominal radiographs of 30 patients with clinically confirmed sigmoid volvulus were obtained from the teaching files of four hospitals and were retrospectively reviewed. These radiographs were compared with abdominal radiographs of 28 individuals, each of whom had a dilated colon but not sigmoid volvulus. All radiographs had been obtained with the patient in the supine position. RESULTS: The transverse colon was identified in 26 of the 30 patients with sigmoid volvulus. In each of these 26 patients, the sigmoid colon was cephalad to the transverse colon. Of the patients in the control group, the transverse colon was identified in 24 of the 28 patients. In none of these control group patients did the sigmoid colon extend rostral to the transverse colon. Thus, this sign had a sensitivity of 86% and a specificity of 100%. CONCLUSION: A dilated sigmoid colon that ascends cephalad to the transverse colon is a newly described and accurate finding of sigmoid volvulus on abdominal radiographs obtained with the patient supine.

Cholangiographic demonstration of the cholecystohepatic duct of Luschka.

The cholecystohepatic duct of Luschka is demonstrated. This anomaly directly connects the gallbladder to the bile ducts, draining a portion of the right lobe of the liver. The pertinent embryology is reviewed. When accidentally severed, it may cause a bile leak leading to biloma formation. It should be recognized before surgery to alert the surgeon.

Acute thermal injury of the esophagus.

Acute thermal injury to the esophagus has not been reported previously in the radiographic literature. We present a case of a young adult who developed an intramural "blister" that ultimately communicated with the esophageal lumen. A double-contrast esophagogram outlined the resulting mucosal flap. A brief review of other injuries to the esophagus is included.

Cardiophrenic varices in portal hypertension: evaluation with CT.

PURPOSE: To determine the prevalence and appearance of cardiophrenic angle (CPA) varices at computed tomography (CT) in patients with portal hypertension (PHT). MATERIALS AND METHODS: A retrospective review was performed of 148 consecutive contrast material--enhanced abdominal CT scans of patients with PHT. The paracardiac region was assessed for tubular structures suggestive of varices. Variceal diameter and CT attenuation relative to adjacent liver were noted. RESULTS: Tubular structures consistent with CPA varices were noted in 29 cases and were more common on the right side than on the left. Mean CPA variceal diameter was 2.6 mm. In three cases, right CPA varices measured 10-13 mm in diameter, but no variceal enhancement was noted on initial dynamic CT images. Delayed CT demonstrated contrast enhancement that reflected delayed enhancement of the portal venous system. CONCLUSION: CPA varices, particularly on the right side, are not uncommon in patients with PHT. Varices should be considered and excluded as a cause of CPA masses, particularly before percutaneous biopsy. Delayed CT may be necessary to correctly delineate CPA varices.

Imaging of percutaneous tube gastrostomies: spectrum of normal and abnormal findings.

Enteral alimentation is a crucial component of care for the malnourished patient who cannot eat. Until recently, long-term alimentation was delivered through nasogastric tubes or gastrostomy tubes placed at surgery. In the past few years, percutaneous endoscopic gastrostomy (PEG) has almost completely supplanted these traditional methods. PEG is a safer and better-tolerated procedure. The advantages of PEG over nasogastric tubes include greater social acceptance and improved cosmetic appearance, increased ease of feedings, and decreased nasal alar deformities and gastroesophageal reflux. Complications are less common with PEG than with open gastrostomy but still occur in as many as 15% of cases [1-3]. Percutaneous gastrostomies performed using fluoroscopic guidance have complications in approximately 10% of cases [4]. Despite a rapid increase in the use of percutaneous gastrostomies and their placement by radiologists [4], few published reports have described imaging findings after the placement of such tubes. This pictorial essay illustrates a spectrum of normal and abnormal imaging findings observed with the use of PEG tubes, including tube migration and misplacement, infection, tumor seeding along the PEG tube track, and a variety of gastric wall defects and pseudomasses.

Inflammatory fibroid polyp of the esophagus in an HIV-infected individual: case study.

We report an unusual case of a large esophageal inflammatory fibroid polyp in a man infected with the human immunodeficiency virus complaining of dysphagia. Barium studies and computed tomography demonstrated a long, submucosal-appearing, distal esophageal mass which extended into a hiatal hernia. Inflammatory fibroid polyps should be considered in the differential diagnosis of submucosal and polypoid esophageal masses, although distinctive radiographic features are not found.

Idiopathic localized dilatation of the ileum in adults: findings on barium studies.

OBJECTIVE: Idiopathic localized dilatation of the ileum is a rare entity characterized by a sharply demarcated segmental dilatation of the small bowel that is in line with the lumen. It is probably congenital in origin. Although more commonly diagnosed in children, it presents in adults as occult gastrointestinal (GI) bleeding or less often with abdominal pain. On pathologic examination, the mucosa may be ulcerated, but otherwise the wall is relatively normal. We analyzed the radiographic findings in nine previously unreported cases of this condition in adults. MATERIALS AND METHODS: Collaborative efforts resulted in the collection of nine cases from multiple institutions. In five cases, an enteroclysis had been performed; in three, a conventional small bowel series had been performed; and in one, the lesion was seen on a barium enema with reflux into the ileum. The mean age of patients was 52 years. In seven cases, pathologic correlation was available. In the other two patients, long-term clinical follow-up and repeat studies confirmed the diagnosis. Resected specimens showed a thin but otherwise normal wall with normal ganglion cells and nerve plexuses. Ulceration was noted in six of the seven resected cases. Two cases contained heterotopic gastric mucosa. GI bleeding and/or anemia was the most common (77%) presenting symptom. Abdominal pain and/or obstruction was present in slightly less than half the patients (44%). RESULTS: Lesions were 6-21 cm long and 4-13 cm wide, and all were located in the ileum. The dilated segments were bilobate in three cases, multilobate in three, spherical in two, and tubular in the other. The dilated area was always in line with the long axis of the bowel, not projecting to the side. No surrounding masses were seen. Except in three patients in whom ulcers were noted, the mucosa was normal. CONCLUSION: Idiopathic localized dilatation of the ileum should be suspected whenever a sharply demarcated area of lobulated small bowel dilatation is seen in a middle-aged patient with occult GI bleeding. The axial orientation distinguishes this condition from small bowel diverticula (including Meckel's). The lack of surrounding mass, mucosal irregularity, hypermotility, or fistulae help differentiate it from other causes of small bowel dilatation.

Double anal canal: complication of rectal fecalith.

Fecaliths and stercoraceous ulcerations are well-known complications of chronic constipation. The authors present the case of a double anal canal in an elderly man. This anorectal fistula (complex anal fistula) developed as a complication of an impacted rectal fecalith with resultant stercoraceous ulceration. Eventually, a persistent epithelialized canal developed and was demonstrated at double-contrast barium enema examination. The patient remained continent at all times.

MR appearance of bilateral periscapular elastofibromas.

Elastofibroma, although unusual, should be considered in the diagnosis of a periscapular mass. The ability of magnetic resonance to detect and diagnose these lesions is demonstrated.

Crohn's disease: less common radiographic manifestations.

Unusual manifestations of common diseases are still relatively common events. Crohn's disease may involve the entire gastrointestinal tract from the pharynx to the anus. Although the classic findings of ileocolic disease are well known, the changes described above are less commonly encountered. They may be subject to misdiagnosis unless the protean manifestations of Crohn's disease are kept in mind.

Inferior vena cava pseudothrombus in computed tomography using a contrast medium power injector: a potential pitfall.

Of 276 patients undergoing CT using a power injector to deliver contrast material, 71 (26%) demonstrated a pseudothrombus in the suprarenal inferior vena cava. This occurs much more commonly than in patients injected by hand and is a potential pitfall in interpreting these scans.

Transverse colon volvulus: a case report.

Transverse colon volvulus is a rarely encountered disorder that is difficult to diagnose preoperatively. The anatomic, physiological, and mechanical factors that predispose patients to this problem are discussed as well as various therapies. The radiographic appearance is also reviewed.

Severe allergic reaction: an unusual complication of barium enema.

This article describes a severe allergic reaction to a barium sulfate compound used during double-contrast colon examination. This unusual complication is probably induced by chemical agents used as additives in the commercially available barium preparations. The pertinent literature is briefly reviewed.