Evolution of a mycotic aneurysm of the thoracoabdominal aorta.

We report a patient with septicemia who developed a mycotic thoracoabdominal aortic aneurysm over a six-week period. The value of contrast-enhanced computed tomography in the diagnosis of mycotic aneurysms of the aorta is stressed.

Primary pulmonary artery sarcoma mimicking pulmonary thromboembolism.

A 69-year-old woman presenting with dyspnea had a pericardial window created for fibrinous pericarditis. The patient subsequently developed pulmonary hypertension and a ventilation perfusion scan was compatible with pulmonary thromboembolism. A primary tumour of the pulmonary artery was suggested by angiography, computerized axial tomography and magnetic resonance imaging. Pathology confirmed a spindle cell pulmonary artery sarcoma.

Primary osteosarcoma of kidney with liposarcomatous elements.

Extraosseous osteogenic sarcomas are unusual tumors that are seldom diagnosed. Although primary renal osteogenic sarcoma has been reported, and is described in the Armed Forces Institute of Pathology fascicle, most clinicians are unaware of its existence. We describe a patient with this disease to remind clinicians of this tumor, its presentation and rapid evolution.

Intravenous self-administration of metallic mercury.

Embolization of metallic mercury is extremely rare. The literature has consisted primarily of scattered case reports. Two cases of patients with mercury embolization are presented. The differential diagnosis of the chest radiograph is discussed.

Angiographic diagnosis of aorto-inferior vena caval fistula.

Two cases of spontaneous aorto-caval fistula are reported. In the first, following laparotomy for an erroneous diagnosis of acute appendicitis, retrograde aortography was conclusive. In the second case, an attempted renal angiogram for acute renal failure and hematuria failed but a flush aortic injection showed the fistula.

Angiography of angiomatous lymphoid hamartoma (Castleman tumor) and a suggested pathogenesis.

The histological nature and angiographic characteristics of two cases of Castleman tumor support the concept that these tumors are hamartomatous. On angiography, both tumors exhibited a dense and homogeneous blush in the later phase. In one, in the mediastinum, hypertrophied branches of the bronchial artery gave rise to multiple irregular vascular spaces within the tumor; in the other, in the retroperitoneum, hypertrophied branches of the lumbar artery gave rise to irregular vascular channels spaced throughout the tumor. Histologically, both lesions contained numerous lymphoid follicles which, in the central portion, contained capillary vessels with thick hyalinized walls and prominent endothelial cells. A pathogenesis of hamartoma formation is suggested based on a disturbance of the normal orderly replacement of somatic cells and tissues.

The angiographic diagnosis of acute hemorrhagic renal cortical necrosis.

The authors report a case of acute renal failure resulting from acute cortical necrosis. A selective renal angiogram defined a very unusual, abrupt termination of vascularity at the interlobular and arcuate levels. Nephro-angiography is an important tool in the diagnosis of acute cortical necrosis in the initial phase of acute renal failure.

Splenic cystic lymphangiomatosis: an unusual cause of massive splenomegaly.

Two unusual cases of massively enlarged spleens occupied by numerous lymphangiomatous cysts are described. Both angiography and pathology confirm the pathognomonic appearance.

Diagnostic accuracy of cerebral angiography and computerized transaxial tomography.

Computer tomography (CT) of the brain has become widely accepted as an accurate method of studying a variety of intracranial diseases. In a prospective controlled study one group of radiologists interpreted cerebral angiograms and another interpreted CT studies undertaken in the same patients. The overall rates of diagnostic accuracy were similar (81 and 84% for angiography and CT, respectively), albeit less than reported in the literature, and thus support the contention that CT scanning should be available as the initial neuroradiologic examination whenever possible.

Prevention of venous thrombosis with small, subcutaneous doses of heparin.

The effect of low-dose heparin prophylaxis on venous thrombosis and bleeding after major elective surgery was studied in a prospective controlled study of 820 patients. The total incidence of venous thrombosis detected with leg-scanning using fibrinogen labeled with radioactive iodine (125I) was reduced from 16.0% in the control group to 4.2% in treated patients. More important, the incidence of popliteal or femoral vein thrombosis was reduced from 2.9% to 1.0%. Prophylaxis resulted in a slight increase in bleeding-minor wound hematoma, mean volume of blood transfused, and a post-operative hematocrit fall in treated patients. However, increased bleeding was clinically minor, and prophylaxis was well tolerated.

The role of angiography in the management of intestinal carcinoid.

Carcinoid tumors of the intestine may present with bowel obstruction or with the carcinoid syndrome. Confirmation of the diagnosis by biochemical means is easy. Management is often surgical and a number of different procedures have been advocated, e.g. resection of the primary, hemicolectomy and lately, partial hepatectomy. The angiographic features of two cases are presented and discussed; the usefulness of the information so gleaned in the choice of management is stressed.