Traumatic luxation of the heart.

A case of luxation of the heart resulting from blunt thoracic trauma is presented. Pericardial defect with herniation of the heart was discovered preoperatively and successfully repaired with a pleural patch. Special attention is drawn in the report to the preoperative diagnosis of this life-threatening condition.

The diagnosis and follow-up of pediatric sinusitis: Water's view radiography versus ultrasonography.

Water's view plain film radiography was compared with ultrasonography in the diagnosis and follow-up of acute maxillary sinusitis in 85 children (170 sinuses). At the first visit, the concordance of the two modalities was 91%, but 20 days later, when the symptoms and signs had disappeared, it was only 76%. At the latter date, the concordance between radiography and clinical findings was 71% and between sonography and clinical findings, 93%. The two modalities studied appear to be equally useful in the initial diagnosis of acute maxillary sinusitis. The loss of back-wall echo correlates well with symptomatic improvement of acute sinusitis. Sonography is also nonionizing and inexpensive, and the examination is simple to repeat.

Ultrasonography for diagnosis of obstructing ureteral calculus.

The reliability of ultrasonography in diagnosing ureteral obstruction caused by calculus was prospectively investigated. In 60 consecutive cases sonograms were compared with excretory urograms. The sonographic diagnosis was correct in 27 (79%) of the 34 cases shown by urography to have ureteral obstruction, and the sonograms showed the causal calculus in 17. The rate of false negative sonographic diagnosis was thus 21%. In two patients with no urographic abnormality, the sonograms indicated ureteral calculus without signs of obstruction. Ultrasonography may be used as an alternative to emergency urography for initial imaging in cases of suspected ureteral obstruction, but urography remains the standard method for evaluating the obstructed urinary tract, due to its greater accuracy and ability to assess renal function.

Adverse reactions after iohexol lumbar myelography: influence of postprocedural positioning.

A prospective study of 110 patients having iohexol lumbar myelograms indicates that patient positioning does not significantly influence the frequency of adverse postprocedural reactions. Thus, after the procedure, patients may be allowed to choose either ambulation or bed rest with their heads raised.

Diagnostic contribution of routine cerebro-spinal fluid analysis during myelography.

The laboratory summary sheets and patient charts concerning 500 consecutive myelograms were reviewed to see whether a routine cerebro-spinal fluid analysis at the time of a neuroradiological procedure made any significant diagnostic contribution. A relatively high frequency of abnormal findings was noted but in no case was significant clinical information obtained. Routine cerebrospinal fluid analysis during myelography does not on the basis of this study seem appropriate.

Preliminary experience of magnetic resonance imaging in neurosarcoidosis.

Twelve MR scans performed on seven patients with neurosarcoidosis are presented. The most common abnormalities were ventricular enlargement (four patients) and diffuse periventricular white matter changes (three patients). Infarcts were seen in three patients and mass lesion in one. The lesions were seen in both T1 and T2 weighted images. The results are compared with CT findings. MRI seems to be more sensitive than CT in detecting white matter changes and infarcts. Ventricular enlargement and granulomas were equally well seen with both modalities.

Sonography as an adjunct to plain film in the evaluation of acute abdominal pain.

A prospective clinical study was made in order to determine the value of routine sonography in conjunction with plain abdominal films on 150 patients with acute abdominal symptoms. In 23% important diagnostic information was achieved, most commonly in acute biliary disease. Less important pathological entities were revealed in 21% of the patients. In 1% sonography yielded misleading information. The use of sonography should be increased and it might be recommended as an adjunct to plain film evaluation in patients with acute abdomen if plain films do not reveal the reason for abdominal symptoms.

Hypodense white matter lesions in computed tomography of neurosarcoidosis.

Cerebral CT was performed on 32 patients with neurosarcoidosis and found to be abnormal in 13 (41%). One of the most common abnormalities (five patients) was represented by low density white matter lesions, which have not, to the best of our knowledge, been previously reported in association with neurosarcoidosis. Other types of abnormalities were ventricular enlargement (five patients) and mass lesions (four patients). Nineteen of the 32 patients had normal CT findings; thus normal CT does not exclude neurosarcoidosis. Nine magnetic resonance examinations carried out in seven patients failed to reveal more lesions than CT.

Direct coronal CT: an aid to the diagnosis of sellar lesions.

The qualities of the CT scanners used have a decisive influence on the results presented in various papers dealing with sellar CT examinations. Our conclusions are presented with this in mind. In the great majority of cases, direct coronal CT through the sellar area is available and gives essential information about this region. The size and origin of a tumour can be determined and differential diagnosis between a tumour and an empty sella is possible. Coronal scanning must be considered a necessary part of sellar region CT. The use of lateral digital localizer seems essential in order to avoid the main shortcoming of this modality, namely artifacts caused by metallic dental fillings. However, in a certain significant number of cases difficulties still exist. Artifacts cannot always be avoided and diagnostic slices cannot then be obtained. The differential diagnosis between an empty sella and a cystic lesion, between different tumour types or between an aneurysm and tumour may also sometimes be impossible. Computer histographic analysis, sequential or dynamic CT studies as well as carotid angiography may increase the chances of differential diagnosis between neoplasms, and carotid angiography is essential in the detection of vascular lesions. The problem of truly reliable microadenoma detection has not so far been solved. The significant frequency of examinations spoiled by artifacts emphasizes the need for high quality reconstructions and also points to the fact that metrizamide cisternography with hypocycloid tomography still has a definitive role in radiological examination of the sellar area.

Lateral C1-C2 puncture: a technique to reduce adverse reactions in metrizamide sellar cisternography.

Fifteen metrizamide sellar cisternograms performed with lateral C1-C2 puncture are presented. The technique is explained and adverse reactions are compared with those reported in cisternograms performed with lumbar injection. Attention is drawn to the simplicity of the method, the small amount of contrast medium required and the few and mild adverse reactions.

Metrizamide cisternography with hypocycloid and computed tomography in sellar and suprasellar lesions.

Metrizamide cisternography with both hypocycloid and computed tomography was performed on 23 patients with a sellar or a suprasellar lesion. The degree of an extrasellar tumour extension or the presence of an empty sella was detected precisely. The procedure was easy to perform and the side-effects were mild to moderate in most patients. When used carefully this diagnostic method provides valuable information when choosing the appropriate treatment for patients with sellar or parasellar lesions.

Computed axial tomography of pituitary adenomas.

Computed axial tomography is an excellent screening procedure in patients suspected of having a tumour in or near the sella turcica. Even microadenomas can sometimes be diagnosed, although not excluded, pluridirectional tomography remaining the most accurate method for their detection. Differentiation of adenomas from other parasellar tumours is not possible by computed tomography alone. An empty sella can be differentiated reliably from tumorous sellar enlargements although cystic adenomas can cause difficulties in differential diagnosis. The amount of anteroposterior and lateral extensions can be determined but the exact suprasellar extension cannot be estimated. Coronal sections of intrathecal enhancement with either conventional or computed tomography help in these cases. Carotid angiography is needed to differentiate vascular lesions from non-vascular ones.

Pituitary function in patients with enlarged sella turcica and primary empty sella syndrome.

The pituitary function in 20 patients with primary empty sella syndrome has been evaluated. The only endocrine symptom was secondary amenorrhoea in four patients. In half of the patients, pituitary function tests showed minor abnormalities, the most common being impaired growth hormone response to glucagon. In addition to the empty sella, other intracranial abnormalities such as pituitary tumour and hydrocephalus were found in four patients. Although commonly a benign condition, the empty sella may occasionally be associated with clinically important endocrine dysfunction, pituitary tumours and other intracranial abnormalities.

The normal suprasellar subarachnoid space in computed tomography.

Changes in visibility or configuration of the suprasellar cistern are often the only signs on a CT scan of a patient with a juxtasellar expansion. Normal variations of this subarachnoid space on a CT scan are side for anatomical and technical reasons. The ability to differentiate between normal and abnormal in this area is essential in interpreting computed axial tomograms. To determine normal variants of the suprasellar cistern, 456 consecutive standard tomograms interpreted as normal were reviewed. The cistern was visible in 73.7% of the scans and the shape of the cistern was found to be either hexagonal (71.5%) or tetragonal (28.5%). The visible content of the cistern included the anterior part of the third ventricle (55.5%), the optic nerves and/or chiasm (52%) and the dorsum sellae (34.9%). The content of the cistern could not be accurately defined in 24.8% of the scans. In about one-fourth of the scans the suprasellar subarachnoid space was not visualised at all. If any doubt exists as to the visibility and configuration of the suprasellar cistern when there is a clinical suspicion of a juxtasellar tumour, additional investigations must be performed.

Diagnosis of primary empty sella syndrome by computed tomography.

Eight cases of primary empty sella diagnosed on pneumoencephalography (PEG) were examined using computed tomography (CT). The diagnosis was made correctly in every case and it was possible to differentiate an empty sella from a pituitary adenoma. Slices 5 mm thick and an overlapping technique were necessary because of the small volume of the tissues analysed. PEG does not seem to be necessary in most cases of suspected intrasellar cisternal herniation, and it is needed only in the difficult case in which the clinical picture and the CT finding are not in harmony.