Renal artery embolism. Correlation with scintigraphic and radiographic findings.

The diagnosis of renal artery embolism should be considered in patients with cardiac disease who present with abdominal or flank pain in association with deteriorating renal function. Often the diagnosis is delayed or missed owing to the nonspecific, varied, and protean clinical manifestations. A case is presented of bilateral renal artery emboli, and initial and long-term scintigraphic and radiographic correlations are provided. Renal scintigraphy should be the initial study of choice. In addition, this procedure allows for sequential noninvasive evaluation of renal function.

Prompt visualization of the gallbladder with a rim sign--acute or subacute cholecystitis?

An immunosuppressed, neutropenic patient developed symptoms and signs of acute cholecystitis. Gallbladder ultrasound was consistent with acute cholecystitis. Technetium-99m-diisopropyl iminodiacetic acid (DISIDA) scan showed a rim sign, but with normal gallbladder visualization. On restudy 72 hr later when the patient's WBC count was recovering, the 99mTc-DISIDA scan again showed a persistent rim sign, but now there was no gallbladder visualization at 1 hr, a pattern strongly predictive for acute complicated cholecystitis. Biliary drainage was performed by percutaneous cholecystotomy with clinical improvement. Semielective cholecystectomy performed 8 wk later confirmed both acute and chronic cholecystitis. We describe the rim sign and its variants, mechanisms of causation, prognostic importance and correlate our report with a review of the literature.

Comparison of L-hyoscyamine, glucagon, and placebo for air-contrast upper gastrointestinal series.

Previous studies have compared the use of anticholinergic drugs and glucagon for upper gastrointestinal (UGI) radiography. Many radiologists prefer glucagon because these comparisons showed it to have a shorter duration of action with fewer side effects. L-Hyoscyamine is the levo-rotatory form of atropine with minor adverse side effects. This study compared the effects of glucagon (N = 48), L-hyoscyamine (N = 43), and placebo (N = 45) on gastric and duodenal distension, mucosal coating, and patient tolerance. L-Hyoscyamine provided gastric and duodenal images equal in quality to glucagon. Except for the more frequent reporting of dry mouth with L-hyoscyamine, side effects were not different among the groups. L-Hyoscyamine is an economical alternative to glucagon for hypotonic gastrointestinal radiography.