Initial experience with percutaneous placement of the PAS port implantable venous access device.

The authors evaluated a new venous access port designed for peripheral venous insertion in the interventional radiology suite. Forty ports were placed in 40 patients in either the brachial, cephalic, or basilic vein under fluoroscopic guidance. These ports have been used for blood transfusion, blood sampling, parenteral nutrition, chemotherapy, and antibiotic therapy. The ports have been in use for 4,241 consecutive patients days. There have been no clinically apparent venous thrombotic complications and only one device-related infection. The cost and risk of complication are less than those for a surgically placed chest wall port, and the cosmetic result is excellent. This port has had excellent patient, nursing, and clinical acceptance.

Resident interpretation of emergency computed tomographic scans.

Our busy, urban emergency room is staffed by radiology residents after working hours. To determine the accuracy of our residents' interpretations of emergency cranial computed tomographic (CT) scans, the authors reviewed the preliminary reports of our residents for a two-month period. A total of 289 cranial CT scans were retrospectively reviewed and the resident interpretation judged acceptable, minor error, moderate error, or major error. Six of 289 neurologic examinations (2%) had moderate (4) or major (2) errors. The mistakes all involved misinterpretation of cerebral hemorrhage. The 98% accuracy in interpretation of cranial CT is higher than the accuracy reported with emergency plain film (PF) interpretation.

Objective assessment of swallowing function in head and neck cancer patients.

Swallowing function was evaluated with scintigraphy in 37 patients with head and neck cancer. The patients were examined before and during the course of either surgery, chemotherapy, and/or radiotherapy. A total of 118 scintigraphic studies were performed. Scintigraphic results of bolus flow and aspiration were correlated with clinical findings. Both scintigraphic and clinical studies indicated a worsened swallowing function in 12 patients. These same studies indicated improvement of swallowing in another 13 patients. In 11 patients, both studies revealed either no apparent change or mixed changes in swallowing function after the course of therapy. In only 1 patient was there disagreement between the scintigraphic and clinical assessment of swallowing function. It is our opinion that scintigraphy is a useful method for objective assessment of swallowing function during and after the course of treatment of head and neck cancer patients.

Surface coil FLASH magnetic resonance imaging of the fasting and secretin-stimulated pancreas.

The purpose of this study is to investigate the response of the pancreas to secretin stimulation using magnetic resonance imaging (MRI). Using the Siemens 1.0 T Magnetom and a Helmholtz surface coil, single breath FLASH-MRI of the normal fasting pancreas was performed in the prone position, both before and after a 20-minute period after intravenous (IV) bolus injection of secretin (2 cu/kg). T2*-weighted fast low-angle shot sequences (TR = 150 mseconds; TE = 30 mseconds; flip angle = 10 degrees; matrix = 256 X 256; acquisitions = 2) demonstrated an immediate response manifested by a significant distension of the duodenum with fluid secreted by the pancreas, as well as a gradual decline of the pancreas/muscle signal intensity (SI) ratio over time. Twenty minutes after secretin administration, the mean percent decrease of the pancreas/muscle SI ratio in six volunteers was 11.6 +/- 6.4 (1-STD). This is statistically significant (P less than .003) given a mean percent increase of the pancreas/muscle SI ratio of 1.6 +/- 4.8 (1-STD) in five volunteers 20 minutes after bolus injection of saline (control). Although significant duodenal distension is easily demonstrated after secretin administration, the decrease of the relative pancreatic SI over time is visually subtle. Further work is needed to enhance imaging of the physiologic response of the pancreas using even more rapid imaging techniques.

Scintigraphic findings in patients with shoulder pain caused by interleukin-2.

Interleukin-2 is receiving widespread interest as an immunotherapeutic agent in the treatment of certain cancers. Severe arthralgias recently have been reported as a significant side effect, and the cause of pain is unknown. Because interleukin-2 is an immune modulator, we reviewed the 99mTc-methylene diphosphonate scintigrams in nine patients who had developed shoulder arthralgias while receiving interleukin-2 for metastatic melanoma. In eight of the patients, the scintigrams showed diffuse increased uptake of radionuclide in the shoulders. Four patients had radiographs of their shoulders, all of which were normal. Bone scintigraphy in patients receiving interleukin-2 as immunotherapy for metastatic melanoma shows increased radionuclide activity in the shoulders. This process may relate to the role of interleukin-2 as a mediator in the inflammatory response.

Nuclear scintigraphy in the evaluation of renal colic.

Forty patients with acute onset renal colic were studied using technetium-99m DTPA renal scintigraphy. Thirty-two were found to have varying degrees of obstruction. In the obstructed group the level was determined by the scan alone in 24 of 32 cases (75%). When the analysis included an abdominal radiograph, the level of obstruction was ascertained in 29 of 32 cases (91%). A delayed nephrogram, as evidenced by an "empty renal pelvis sign" at 5 minutes, was observed in all but one of the cases of obstruction (97%). Delayed clearance of activity from the pyelocalyceal system or ureter was also seen in 97%. In all cases of obstruction either one or both of these signs were observed. However, delayed clearance was found to be a nonspecific finding and was noted in 25% of nonobstructed cases. The finding of the "empty renal pelvis sign" at 5 minutes was found to be specific and was not seen in the nonobstructed group. The authors conclude that radionuclide renal scanning is an effective method for evaluating selected patients with suspected renal colic.

The groin hit: complications of intravenous drug abuse.

We are seeing an increased number of complications in intravenous drug abusers who resort to injecting the groin for vascular access (the "groin hit"). Vascular complications include venous thrombosis, arteriovenous fistula, mycotic aneurysm, ruptured pseudoaneurysm, and dissecting hematoma. Soft tissue complications include cellulitis and abscess. The latter may dissect into the extraperitoneal space. Skeletal complications include osteomyelitis and septic arthritis. This paper illustrates the radiographic spectrum of these complications. An algorithm will illustrate the radiographic evaluation of a groin mass in a drug addict.

Cocaine abuse: neurovascular complications.

In a review of the records of 3,712 drug abusers, 13 patients were identified with neurologic deficits attributable to the use of cocaine. Ischemic manifestations were the most frequent, occurring in seven (54%) patients, with a mean age of 34.2 years. Three (23%) patients had subarachnoid hemorrhage, and three (23%) had intracerebral hemorrhage. Three patients from other institutions were included in the analysis, for a total of 16 patients, (eight with cerebral ischemia, four with subarachnoid hemorrhage, and four with intracerebral hemorrhage). Of the six patients with head computed tomographic findings of cerebral infarction, five had subcortical infarcts. Two of the four patients who presented with a subarachnoid hemorrhage had a congenital intracranial aneurysm. One of the four patients with an intracerebral hemorrhage had an underlying arteriovenous malformation. The mechanism through which these complications occur is not completely understood. Factors that may play a role include the acute hypertensive response that occurs with cocaine use as well as disordered neurovascular control.

Pyogenic sacroiliitis in i.v. drug abusers.

We evaluated the sensitivity of imaging studies in six IV drug abusers who had back pain from pyogenic sacroiliitis. Initial radiographs of the sacroiliac joints showed bone destruction in two. A third had slight joint narrowing and sclerosis resembling degenerative disease. Radiographs were considered normal in three. Two of the patients with initially normal radiographs subsequently showed loss of cortices on follow-up studies within 2 weeks. All of the patients had increased activity on scintigrams (five were obtained with technetium-99m methylene diphosphonate; one was with gallium). The findings suggest that scintigraphy is useful in the detection of pyogenic sacroiliitis in IV drug abusers when plain films are normal.

Computed tomography of nephrogenic adenoma of the urinary bladder.

Nephrogenic adenoma of the urinary bladder is a rare benign tumor. It is generally accepted that the tumor represents metaplasia of the urothelium in response to chronic inflammation or injury. Its CT appearance can be similar to that of carcinoma of the bladder.

Computed tomography of acute renal abscess due to Salmonella chester.

A case of renal abscess caused by an unusual Salmonella serotype is presented in which the clinical presentation was suggestive of renal neoplasia. The CT findings of renal abscesses and neoplasm are discussed as well as a brief discussion on the epidemiology of Salmonella infections.

Computed tomographic evaluation of the excluded stomach in gastric bypass.

Eleven patients who had gastric bypass operations were examined with computed tomography to evaluate the status of the excluded stomach. Three of the patients had dilated excluded stomachs that accounted for the patients' symptomatology. As an upper gastrointestinal series cannot delineate the excluded stomach, computed tomography is the examination of choice for such an evaluation.

The spectrum of computed tomographic appearance of metastatic masses from testicular neoplasms.

Metastatic masses from testicular neoplasms were evaluated with respect to their computed tomographic characteristics. They were divided in three categories: cystic, semicystic, and solid. The common denominator in the first two categories was the presence of teratomatous components. The nonteratomatous masses were solid.

Celestin tube use: radiographic manifestations of associated complications.

Celestin intubation of the esophagus is occasionally employed in the palliation of unresectable esophageal carcinoma and in the obturation of malignant tracheoesophageal fistulas. Fourteen of 192 patients with carcinomas of the esophagus had Celestin tubes inserted at our institution between October 1977 and October 1982. Although tube insertion carries a low operative risk, there is significant subsequent morbidity associated with its use. Complications were identified radiographically in 11 of the 14 patients. Gastroesophageal reflux with aspiration pneumonia, tube obstruction, and tube migration were demonstrated most often. When Celestin tube use is deemed appropriate, the clinician and radiologist should be aware of the possible complications.

Lipoma of the myocardium.

A case of myocardial lipoma is presented which was diagnosed by computed tomography (CT). The resultant distortion of the cardiac chambers was well delineated by CT.

Cavitation of squamous carcinoma of the lung.

This study indicates that a good percentage of the cavitary squamous cell carcinomas of the lung can be suggested throught the use of sputum cytology. Hyperkeratinized malignant cells associated with varying degrees of karyorrhexis, "ghost cells," and a diathesis of purulent exudate are helpful in the identification of this tumor type. The cell population found cytologically can be demonstrated in the histologic sections of cavitary squamous cell carcinoma of the lung. We readily admit that the application of the above criteria will not decrease the mortality or morbidity of lung cancer, but can be used as a refinement of a diagnostic tool.