Angioplasty of subclavian artery stenosis proximal to the vertebral origin.

Percutaneous transluminal angioplasty was performed in nine patients with symptomatic proximal left subclavian artery stenoses. All cases were technically successful. One significant delayed complication occurred in a patient whose common carotid-to-subclavian artery bypass graft occluded several months after a successful subclavian artery angioplasty with a probable subsequent embolic occlusion of the internal carotid artery. The other patients were asymptomatic after follow-up evaluations of 4-23 months.

Cholangiographic demonstration of postoperative bile leakage from aberrant biliary ducts.

Copious persistent postcholecystectomy biliary fistula may result from severing a large unrecognized aberrant duct from the right lobe of the liver that empties into the gallbladder or cystic duct. Recognition of aberrant biliary ducts and identification of the major intrahepatic biliary radicles on cholangiography are emphasized. Two cases are presented. In 1 case percutaneous transhepatic cholangiography (PTC) made the diagnosis. PTC is a safe, accurate method for evaluating postcholecystectomy biliary fistula.

Renal carbuncle: the use of ultrasound in its diagnosis and treatment.

The use of ultrasound in the diagnostic and therapeutic management of 5 patients with renal abscesses is described. A spectrum of ultrasonic findings was noted, with the majority of the lesions being anechoic (3 cases). However, a few lesions showed a mixed pattern (2 cases). Ultrasonic aspiration of abscess fluid for culture and sensitivity obviated an operation in 1 case. For the first time, ultrasonically guided, percutaneous, indwelling catheter drainage of a renal carbuncle is reported. Since the patient had failed to respond to systemic antibiotic therapy this technique saved the patient from undergoing an operation. The clinical and ultrasonic findings in the 6 previous case reports of abscesses are reviewed.

Transitional cell tumors of the kidney: how diagnostic is the angiogram?

Angiograms of 51 tests cases including 34 transitional cell carcinomas, eight inflammatory lesions, four hypernephromas, and five miscellaneous disorders were shown to six radiologists for analysis of the angiographic features and specific diagnosis. Overall accuracy was 60% with a false positive rate of 44%. The most common false positive diagnosis occurred with inflammatory lesions (seven of eight). False negative cases were variously called normal, hypernephromas, inflammatory, or other. Vessel encasement (26%), neovascularity (56%), and tumor blush (15%) were recognized far less frequently in the transitional cell tumors of this series than in previous reports in the literature. Further, when hydronephorsis was present, the angiogram was not helpful in determining the etiology. It is concluded that the "classic" angiographic findings associated with this tumor are only moderately reliable since they can be mimicked by other conditions.

Testicular venography in the nonpalpable testis.

Localization and identification of a nonpalpable testis can be done accurately by testicular venography. The identification of the pampiniform plexus is essential to the localization of the testis by this method. We evaluated 15 patients 3-39 years of age with 21 nonpalpable testes. Fourteen successful testicular venograms were performed showing four retroperitoneal testes, four testes within the inguinal canal, and two testes located in the superficial inguinal pouch. Three nonpalpable testes were thought to be due to true agenesis, and one venogram was performed after prior surgical removal of the testis. Catheterization of the left testicular vein was accomplished with greater ease and accuracy (79%) to the right side (42%).

Esophagogastric fistula. A complication of combined operations for esophageal disease.

Esophagogastric fistula developed in two patients following operations combining fundoplication and other operative procedures on the esophagus. To our knowledge, this complication has not been previously reported or described. Accurate endoscopy and appropriate barium roentgenographic studies provided the definitive diagnosis. A second reconstruction was successful in one patient; conservative treatment was sufficient in the other.