Treatment of a patient with an infected hepatic cyst.

Symptomatic hepatic cysts are infrequently seen by family physicians. We review the literature and describe the diagnosis and management of a patient with cystic liver disease and a dominant infected hepatic cyst. The treatment included percutaneous drainage, intravenous antibiotic therapy, and sclerotherapy infusion using sterile alcohol (95% ethanol).

Small bowel perforation during enteroclysis.

Small bowel perforation with massive intraperitoneal leakage of barium occurred during the performance of enteroclysis in a 72-year-old woman. It is postulated that an ischemic segment of the partially obstructed ileum had ruptured because of rapid intraluminal flow of contrast material and increased abdominal pressure when the patient was rotated to a prone position.

Geophagia: an uncommon cause of acute abdomen.

Two cases of geophagia (dirt eating) that were diagnosed radiographically are presented. The clinical presentation mimicked urgent surgical conditions. The characteristic radiographic appearance provided a major clue to the correct diagnosis. An intense clinical history is often necessary to reach the specific diagnosis and properly manage the condition.

Post-traumatic splenic hematoma hidden by an overdistended stomach: use of nasogastric to avoid pitfalls.

The use of a nasogastric tube to empty the stomach contents prevents compression of the splenic parenchyma and allows clear visualization of the anterior medial border of the spleen and perisplenic area. Unsuspected superficial lacerations or a contained hematoma by the splenic capsule may become apparent only following this procedure. A representative case is reported. Routine application of this simple procedure aids avoiding occasional pitfalls and helps in early diagnosis of splenic injury at the time of a CT study.

Herpes esophagitis in immunocompetent patients.

Although herpes simplex virus is a recognized cause of esophagitis in immunocompromised patients, it may also be the etiologic agent in otherwise healthy individuals. Odynophagia and dysphagia are the major symptoms. The esophagogram may reveal ulcers in the distal esophagus and there may be motor disturbances as well. Esophageal endoscopy may show vesicles, ulceration or plaques. In the immunocompetent patient, herpes esophagitis is a self-limited disease.

Spigelian hernia.

The clinical diagnosis of Spigelian hernia can be difficult due to lack of specific and constant findings. We report two patients whose only symptoms on presentation were progressive abdominal pain and intermittent palpable mass. The radiographic demonstration of bowel extending outside the expected confines of the peritoneal cavity allowed prompt diagnosis and proper operative management in both patients. Spigelian hernia requires surgical correction to prevent complications of acute abdomen with strangulation or incarceration.

Cholangiocarcinoma arising in a choledochal cyst: diagnostic value of computed tomography and ultrasonography.

A case of cholangiocarcinoma arising in a choledochal cyst (type II or biliary cyst in Alonso-Ley classification) in a 53-year-old woman is presented. Ultrasonography and computed tomography provided the correct preoperative diagnosis. The value of these modalities in presurgical planning is illustrated.

Malignant lymphoma in Hashimoto thyroiditis: CT appearance.

A case of malignant lymphoma arising in a patient with Hashimoto thyroiditis is presented. Computed tomography revealed a large, well encapsulated unilateral mass without adenopathy. The CT appearance in light of the clinical and laboratory data strongly suggested the diagnosis of lymphoma in favor of carcinoma.

Calcified rims. Uncommon radiologic finding and potential pitfall due to organization of deposits of oyster shell tablets.

In a patient undergoing double-contrast barium enema (DCBE) for evaluation of recent onset of diarrhea, a curvilinear strand of calcifications outlining a filling defect of the cecum, initially thought to represent a neoplasm, later was discovered to be due to precipitation and organization of orally ingested calcium in an adherent fecalith. Colonoscopy and repeated x-ray evaluation avoided the pitfall. This case illustrates the need for analysis and correlation of the type of calcifications characterizing a mass in light of the clinical history. Errors in interpretation can be avoided by asking the patient about oral medications and obtaining delayed films. Colonoscopy may be the diagnostic test in doubtful cases.

Seeding of malignant lymphoma along the tract after bone marrow biopsy.

A 74-year-old man with non-Hodgkin's lymphoma had seeding of tumor along the needle tract after bone marrow biopsy. This complication was recognized by computerized tomography.

Concurrent dissection and intracaval rupture of an abdominal aortic aneurysm: CT findings.

The CT findings of a concurrent dissection and intracaval fistula of an arteriosclerotic aortic aneurysm are reported. Recognition of the CT features of this severe and unusual complication is important for planning effective surgical treatment.

Real-time ultrasonography in the diagnosis of intussusception.

Adult intussusception may be difficult to detect. Clinical findings are variable and standard radiographic studies are not always helpful. In a patient with colocolic intussusception complicating carcinoma, the radiographic examination was normal and the definitive diagnosis was established by real-time ultrasonography alone. This procedure is noninvasive, rapid, painless, inexpensive and devoid of complications or contraindications.

Computed tomography in the evaluation of chest lesions in the pediatric patient.

The role of computed tomography (CT) in the management of chest masses in the pediatric patient is emphasized and illustrated. Thirty-seven patients with various chest lesions who had both CT and conventional radiologic evaluations are reviewed. CT was the most consistently accurate examination, especially in the evaluation of disease extent and relationship with other organs. CT was the only modality to provide clinically useful information in 27% of the cases, and it provided significant additional information in another 24% of the group.

Carcinoma of the cervix: lymphangiography and computed tomography.

Twenty-four patients with carcinoma of the uterine cervix examined by lymphangiography followed by computed tomography (CT) were reviewed to assess the findings and their impact on management. The lymphangiogram was of value in detecting metastases in relatively small nodes, (less than 1.5 cm maximum diameter) and in differentiating metastases from reactive hyperplasia in the larger lymph nodes which were opacified. Although as yet unable to define alterations in the internal architecture of lymph nodes. CT detected masses of lymph nodes totally replaced by neoplasm or those not visualized by lymphangiography. In addition, the local extension of the primary neoplasm and distant metastases, such as to the urinary tract, liver, and skeleton, were readily demonstrated by CT. In advanced or recurrent disease, CT provided new information on 10 of 17 patients but resulted in a change in management for only one.

Computed tomography in hepatic lymphoma.

Computed tomographic (CT) examinations of the abdomen, performed in 323 patients with lymphoma, were reviewed to determine the value of CT in detecting lymphomatous involvement of the liver and the CT appearance of hepatic lymphoma. Additionally, the CT scans were compared with the radionuclide scans. Of 95 patients in whom histological studies were performed, 65 had undergone both CT and radionuclide scanning. CT was found to have a sensitivity of 57% and a specificity of 88%. Radionuclide scans had a sensitivity of 71% and a specificity of 81%. No specific pattern of involvement was revealed by CT. No correlation was found between the type of lymphoma and evidence of liver involvement on CT or radionuclide scans. The results of studies of the spleen are also briefly reviewed. False-positive results of CT examinations were usually the result of technical artifacts. CT and radionuclide scans are comparable in their ability to detect hepatic involvement by lymphoma; however, because CT also provides information on abdominal lymph nodes, it is the preferable examination.

Cranial computed tomography of malignant melanoma.

Two hundred seventy-five cranial computed tomography (CT) scans performed on 179 patients with malignant melanoma were reviewed. Of the 101 patients with confirmed cerebral metastases, CT demonstrated lesions in 93. In 72% of these, areas of increased attenuation were present in the precontrast scan. These lesions also enhanced after contrast infusion. There was a direct correlation between the extent of bleeding in the neoplasm and the density of the metastasis, at least 20% red blood cells per high power field were consistently present within lesions of increased attenuation. Cerebral metastases were occasionally associated with subdural or intracranial hemorrhage. Meningeal melanomatosis was recognized by CT only when associated with adjacent parenchymal metastases. In nine (11%) of 74 patients without clinical evidence of brain involvement, CT revealed cerebral metastases; this suggests that a staging CT scan might be useful on patients with diffuse or advanced local extracranial disease prior to definitive therapy.

Computed tomography in liposarcoma.

Seventeen cases with proven liposarcoma were evaluated by computed tomography (CT) to assess the specificity and value of this radiographic modality. A specific diagnosis of liposarcoma could be made in only four cases (22%). Despite its relative nonspecificity, CT proved extremely useful in the clinical evaluation of this tumor and evidenced considerable superiority to other radiographic methods. In several cases, CT was the only radiographic modality to demonstrate the presence of the lesion. The use of CT gained additional important information in approximately 50% of the cases studied.