Magnetic resonance imaging in Paget disease of the skull.

Four cases of Paget disease of the skull were studied with magnetic resonance (MR) imaging. With optimal use of projection and technical factors, MR permits simultaneous demonstration of osseous deformity and its relation to the underlying soft tissues. Effects on the brain caused by thickened calvaria and brainstem compression from basilar impression can be detected readily on a single sagittal scan.

Mucosal surface patterns of the duodenal bulb. Subject review.

While the duodenal mucosa usually exhibits a smooth, featureless surface on the double-contrast barium examination, on occasion a fine mucosal pattern can be demonstrated. Several pathological processes, including erosive duodenitis, Crohn disease, and celiac disease, may produce subtle alterations in the normal surface pattern. Various normal and abnormal mucosal patterns are illustrated.

Double-contrast enema examination for detection of rectal carcinoma.

The role of the double-contrast enema examination (DCE) in the detection of rectal carcinoma was evaluated and compared to the proctoscopic examination. Records of 90 consecutive patients with a diagnosis of rectal carcinoma were reviewed. Sixty-six patients had a preoperative DCE. The correct diagnosis was either made or suggested in 91% of these patients. The proctoscopic examination was diagnostic in 86%. The causes of radiologic and proctoscopic error were evaluated. Findings confirm that the DCE is an accurate method for the diagnosis of rectal carcinoma. Careful examination of the rectum should be incorporated in all radiologic studies of the colon since a normal proctoscopic examination does not exclude the possibility of rectal carcinoma.

Candidiasis in the obstructed esophagus.

Four cases of esophageal candidiasis complicating functional or mechanical obstruction are described. The causes of the obstruction included achalasia, scleroderma, and postoperative fundoplication. None of the commonly recognized conditions predisposing to esophageal candidiasis was present. The findings on barium study ranged from plaque-like filling defects to extensive nodularity and roughening of the mucosal surface, which must be distinguished from ingested debris. It is suggested that esophageal stasis of any cause can lead to candidiasis.

Double-contrast examination of the postoperative stomach.

Radiological accuracy in evaluating the postoperative stomach conventionally ranges from 20 to 70% (as reported in the literature). Alternatively, a double-contrast examination can be performed using a high-density barium-suspension effervescent agent and glucagon. No intubation is required. In 40 patients who underwent gastric surgery, comparison of radiologic and endoscopic findings indicates that a high quality double-contrast study was very accurate. There were 7 radiologic errors (18%) in the 40 examinations. However, in the examinations assigned the highest confidence level there were no errors, while in those assigned the next highest level there was 1.

Peritoneal mesothelioma.

Five cases of malignant peritoneal mesothelioma are reported. Its radiographic manifestations consisted of a desmoplastic mesenteric process with or without a localized mass displacing gastrointestinal structures. Appreciation of the nature of this tumor permits pathologic-radiologic correlation and an understanding of the radiographic changes. Though numerous conditions may produce similar findings, combining a history of asbestos exposure or chest radiograph findings of asbestosis with gastrointestinal findings of desomplasia should narrow the diagnostic possibilities.

Transverse folds in the human esophagus.

Fine transverse folds can be seen by double contrast technique in the human esophagus which are similar to those seen regularly in the feline esophagus. These folds are transient in nature and possibly represent contraction of the muscularis mucosae. This fold pattern can be seen in patients with gastroesophageal reflux and in those with no symptoms of esophageal disease. The marginal serration should not be mistaken for diffuse ulceration on barium filled views of the esophagus. Distortion of interruption of the normal fold pattern can be seen in patients with superficial ulceration due to reflux esophagitis or other invasive mucosal lesions. Although the pathophysiologic significance of this phenomenon is uncertain, the demonstration and recognition of these folds allows for better definition of mucosal surface abnormalities.

Double-contrast artifacts.

With the increasing use of double-contrast technique in radiological evaluation of the gastrointestinal tract, certain artifacts peculiar to this mode of examination need to be identified. These artifacts arise because of: (a) the characteristics of the barium suspensions used for double-contrast studies; (b) the see-through effect obtained on double-contrast studies whereby opacities lying in front of or behind the organ being examined may simulate pathologic lesions; (c) infolding of the mucosa which may simulate pathology; (d) extraneous or foreign material which is frequently detected and must be differentiated from intrinsic disease; (e) certain anatomical structures such as the cardia, pylorus, and retrogastric structures which are seen with unusual clarity and detail and which, in some cases, may simulate pathology. In general, these artifacts may simulate diffuse superficial ulceration, discrete ulceration, or polypoid lesions. Familiarity with the double-contrast technique and an understanding of these artifacts will help to avoid diagnostic errors.

Gastrointestinal complications of aortic bypass surgery.

Gastrointestinal bleeding following abdominal aortic bypass surgery is not uncommon, as approximately 20% of patients with abdominal aortic aneurysms have peptic ulcer disease. We have recently seen three patients who presented with gastrointestinal bleeding secondary to the complications of their surgery. The cause of the bleeding was aortoduodenal fistula, graft erosion into the sigmoid colon and ischaemic colitis respectively. The correct diagnosis was only considered in one patient, although in retrospect it should have been suggested in all three. Our experiences with these complications and their clinical and radiological presentation form the basis for this paper.

Hypotonic examination of the colon with glucagon.

The authors report their experience with glucagon in the barium enema examination. Two milligrams of glucagon given intramuscularly was found to be safe and effective in overcoming functional spasm, permitting more detailed evaluation of organic narrowing. The relatively infrequent side effects and few contraindications seen with glucagon make it the drug of choice when reduction in intestinal tone is indicated.