Congenital esophageal stenosis in adults: clinical and radiographic findings in seven patients.

OBJECTIVE: The purpose of this study was to determine the clinical and radiographic findings in seven adults with congenital esophageal stenosis. CONCLUSION: In young or middle-aged individuals, particularly men with long-standing dysphagia, an upper or mid esophageal stricture with multiple ringlike constrictions is a characteristic appearance of congenital esophageal stenosis on double-contrast esophagography.

Three-dimensional multiplanar sonohysterography: comparison with conventional two-dimensional sonohysterography and X-ray hysterosalpingography.

The objective of this study was to assess the value of combining transvaginal sonohysterography with three-dimensional multiplanar ultrasonography to optimize assessment of the uterus. To make this assessment, we compared findings on three-dimensional sonohysterography with those on two-dimensional sonohysterography and X-ray hysterosalpingography. Of 20 women who underwent three-dimensional sonohysterography for various indications, 13 also underwent two-dimensional sonohysterography, and 12 had X-ray hysterosalpingography. We reviewed the 3 types of examinations separately and compared the standard techniques with three-dimensional sonohysterography to determine whether three-dimensional sonohysterography provided additional information. In 9 (69%) of 13 comparisons between three-dimensional sonohysterography and two-dimensional sonohysterography and in 11 (92%) of 12 comparisons between three-dimensional sonohysterography and X-ray hysterosalpingography, three-dimensional sonohysterography was advantageous. The coronal plane was most useful for displaying the relationship between lesions and the uterine cavity. Three-dimensional sonohysterography provided additional information compared with standard accepted techniques in the vast majority of women.

The acute diagnosis of Takayasu's arteritis based on helical CT angiography of the chest and neck in the emergency room.

Recently, a young woman presented acutely with a left hemispheric stroke and differing blood pressures in the arms as her initial manifestation of Takayasu's arteritis. Helical CT angiography, performed to rule out aortic dissection, revealed a thickened wall of the aortic arch with stenoses and occlusions of the great vessels, suggesting the diagnosis. The sequence of imaging studies and findings in this unusually catastrophic presentation of a typically insidious disease are highlighted.

Intravascular ultrasound as an alternative to positive-contrast vena cavography prior to filter placement.

PURPOSE: In a nonconsecutive series of patients, intravascular ultrasound (IVUS) was investigated for safety and efficacy as an alternative to positive-contrast vena cavography for evaluating the inferior vena cava (IVC) prior to filter placement. MATERIALS AND METHODS: In a 6.5-year period, 30 patients (15 women, 15 men) ranging in age from 22 to 98 years old (mean, 56 years) underwent vena cava filter placement without conventional positive-contrast vena cavography, after IVUS evaluation of the IVC with use of a 6.2-F, 12.5- or 20-MHz monorail catheter system. The rationale for using IVUS included contraindications to iodinated contrast material in 14 patients with renal insufficiency and in four patients with previous life-threatening anaphylactoid reaction to iodinated contrast material; limitations to radiation exposure in four pregnant patients; and inability to otherwise image the IVC of eight morbidly obese patients who exceeded the weight limits of available angiographic equipment. IVUS completely replaced positive-contrast vena cavography, although not fluoroscopy in the four pregnant patients and in the 18 patients with contrast material contraindications. In two of the eight obese patients, IVUS was the only imaging modality. RESULTS: In all 30 patients, IVUS successfully determined the patency of the filter delivery route veins and the vena cava, the absence of thrombus, the location of renal veins, the absence of anatomical variants, and the vena cava diameter at the desired filter deployment level. Successful filter placement was confirmed in all 30 patients either with plain film alone (n = 12), IVUS alone (n = 3), computed tomography alone (n = 1), external ultrasound alone (n = 1), IVUS and another imaging modality (n = 10), or by combinations of other imaging modalities (n = 3). There were no complications. CONCLUSIONS: IVUS is a safe and effective alternative to conventional positive-contrast vena cavography for imaging the IVC prior to filter placement in patients with contraindications to iodinated contrast material or ionizing radiation.