Abdominal radiography findings in small-bowel obstruction: relevance to triage for additional diagnostic imaging.

OBJECTIVE: Our aim was to determine which findings on abdominal radiography are relevant for distinguishing complete or high-grade partial small-bowel obstruction from low-grade partial or no small-bowel obstruction. MATERIALS AND METHODS: Admitting abdominal radiographs with the patients in the supine and upright positions were scored for 25 different findings in 81 patients with clinically suspected small-bowel obstruction. Forty-one patients had complete or high-grade partial small-bowel obstruction, and 40 had low-grade partial small-bowel obstruction or no obstruction as determined by enteroclysis examination. Abdominal radiography findings were subjected to statistical analysis for correlation with degree of obstruction. RESULTS: Of 12 radiographic findings strongly associated (p < 0.05) with the severity of obstruction, two findings were found to be the most significant (p < or = 0.0003) and predictive of a higher grade small-bowel obstruction: the presence of air-fluid levels of differential height in the same small-bowel loop and the presence of a mean air-fluid level width greater than or equal to 25 mm on upright abdominal radiographs. CONCLUSION: When both critical findings are present, the degree of small-bowel obstruction is likely high-grade or complete. When both signs are absent, small-bowel obstruction is likely low-grade or nonexistent. Upright abdominal radiographs are important in the examination of patients with suspected small-bowel obstruction and may contribute to the imaging triage of these patients.

Small bowel cancer. Radiologic diagnosis.

The diagnosis of small bowel cancer before it has metastasized continues to be a clinical and radiologic dilemma. This article presents an overview of the role of radiology in the diagnosis of small bowel cancer, describes techniques for optimal radiologic examination, and presents a pictorial essay of the radiologic features and differential diagnoses of these tumors.

Reliability and role of plain film radiography and CT in the diagnosis of small-bowel obstruction.

OBJECTIVE: We compare the reliability and define the role of plain film radiography and CT in the assessment of various severities of small-bowel obstruction. MATERIALS AND METHODS: A blinded retrospective analysis was done on 78 patients who underwent plain abdominal radiography, CT, and enteroclysis to assess for suspected small-bowel obstruction. The findings at enteroclysis and the clinical outcomes were used as standards of reference. RESULTS: The sensitivity of plain film radiography for revealing small-bowel obstruction was 69% (44/64), and its specificity was 57% (8/14). Overall accuracy of plain film radiography was 67% (52/78). The sensitivity and specificity of CT were 64% (41/64) and 79% (11/ 14), respectively. Overall accuracy of CT was 67% (52/78). When obstructions were classified as low- and high-grade partial obstruction, plain film radiography and CT had sensitivities of 86% (24/28) and 82% (23/28), respectively, for high-grade obstruction and 56% (20/36) and 50% (18/36), respectively, for low-grade obstruction. CT revealed the cause of the small-bowel obstruction in 95% (39/41) of those patients in who CT correctly showed the obstruction. CONCLUSION: Plain film radiography and CT had similar overall accuracies in showing small-bowel obstruction of various severities. Plain film radiography should remain the initial method of imaging patients with suspected small-bowel obstruction. The ability of CT to show the cause of small-bowel obstruction makes CT an important additional diagnostic tool when specific management issues must be addressed.

Percutaneous embolotherapy of adolescent varicocele: results and long-term follow-up.

PURPOSE: The authors evaluated the technical success and immediate and long-term results of percutaneous varicocele embolotherapy in the adolescent population. PATIENTS AND METHODS: Fifty-nine adolescent patients were referred for outpatient spermatic venography and possible varicocele embolotherapy. Embolization was attempted with use of detachable balloons, coils, "sandwiched" dextrose, or a combination of these techniques. Data regarding follow-up were obtained through telephone interviews or mailed questionnaires. RESULTS: The technical success rate for spermatic vein occlusion was 90%. Follow-up, obtained in 79% of the patients, ranged from 6 months to 8.75 years (mean, 4 years). Thirty-nine of 42 patients (93%) reported disappearance (n = 31) or only a slight, asymptomatic residual varicocele (n = 8). Three patients reported a recurrence of their varicocele. Complications occurred in three of 59 cases (5%), none had any long-term sequelae. In six cases, embolization was not feasible because of multiple collateral vessels or venous spasm. CONCLUSIONS: Given the convenience of performing the procedure on an outpatient basis, the rapid recovery time, and long-term success and complication rates comparable to those with surgical ligation, we believe spermatic venography and percutaneous embolization is the treatment modality of choice for adolescent varicocele.

Abnormal air-filled spaces in the lung.

The authors reviewed the radiographic and computed tomographic (CT) appearances of abnormal air-filled spaces in the lung that develop in response to lung diseases. The major types of these lung diseases include infection, vessel-related or vascular-embolic disorders, bronchiectasis, emphysema, pulmonary fibrosis, adult respiratory distress syndrome and air-block diseases, and unusual disorders of the lung (such as Langerhans cell histiocytosis, Klippel-Trenaunay syndrome, and tracheolaryngeal papillomatosis). After studying the CT scans, conventional radiographs, and medical records of 150 patients with various abnormal air-filled spaces in their lungs and 300 lung specimens and the corresponding high-resolution CT scans, the authors concluded that mechanisms of air-space formation fall into five basic categories: (a) vascular occlusion or ischemic necrosis, (b) dilatation of the bronchi, (c) disruption of the elastic fiber network of the lung, (d) remodeling of the lung architecture and retractile fibrosis, and (e) multifactorial or unknown mechanisms.

Interstitial radiotherapy of the base of the tongue. Improved non-looping afterloading technique.

P6modification of the non-looping afterloading interstitial technique for tongue-cancer therapy is described. The subsequent risk of tearing or breaking of the tubes, resulting in radioactive sources left as foreign bodies in soft tissues, is reduced. In addition, evaluation of implant position is simplified by the use of radioopaque tubes.