Percutaneous nephrostomy: placement under CT and fluoroscopy guidance.

OBJECTIVE: The purpose of this paper is to present our experience with CT- and fluoroscopy-guided percutaneous nephrostomy tube (PNT) placement and to describe the technique of placement with patients in the supine-oblique position. MATERIALS AND METHODS: A CT scanner was coupled with a ceiling-mounted C-arm for fluoroscopy at the CT table, PNT was done with CT localization and fluoroscopic control. We attempted 148 placements in 129 patients, with most patients in the supine or the supine-oblique position. RESULTS: Successful PNT placement was achieved in 144 (97%) of 148 kidneys. In the native kidney group, 101 (81%) of 124 PNTs were placed with the patients in the supine-oblique position. We experienced no major complications, three (2%) minor complications, and two (1%) catheter dislodgments. CONCLUSION: CT-fluoroscopy control allows routine PNT placement with patients in the supine or the supine-oblique position and is associated with the lowest complication rate to our knowledge.

Glenoid labral tears: prospective evaluation with MRI imaging, MR arthrography, and CT arthrography.

OBJECTIVE: We prospectively compared MR imaging, MR arthrography, and CT arthrography to determine the sensitivity of each technique in detecting glenoid labral tears and in determining whether the labrum is detached or degenerated. SUBJECTS AND METHODS: Thirty patients 19-39 years old (mean, 27 years old) who had either signs and symptoms of shoulder instability or shoulder pain of unexplained origin were referred for diagnostic imaging. Each patient underwent MR imaging, followed by MR arthrography after intraarticular injection of 25 ml of a dilute solution of gadopentetate dimeglumine. Twenty-eight of thirty patients underwent CT arthrography after intraarticular injection of air and radiographic contrast material. Each patient also underwent arthroscopy or open surgery. RESULTS: At surgery, labral tears were found in 28 patients; a detached fragment was found in 26 patients. The labrum was found to be degenerated in 18. A labral tear was detected on MR images in 26 (93%) of 28, on MR arthrograms in 27 (96%) of 28, and on CT arthrograms in 19 (73%) of 26. A detached labral fragment was detected on MR images in 12 (46%) of 26, on MR arthrograms in 25 (96%) of 26, and on CT arthrograms in 13 (52%) of 25. Labral degeneration was detected on MR images in two (11%) of 18, on MR arthrograms in 10 (56%) of 18, and on CT arthrograms in four (24%) of 17. MR arthrography was the best of the three imaging techniques for showing the inferior part of the glenoid labrum and inferior glenohumeral ligament. CONCLUSION: MR arthrography and MR imaging both showed labral tears with greater sensitivity than CT arthrography did. MR arthrography was the most sensitive of the three techniques for detecting a detached labral fragment and labral degeneration. Furthermore, MR arthrography afforded the best visualization of the inferior part of the labrum and the inferior glenohumeral ligament. MR imaging and MR arthrography also enabled direct visualization of rotator cuff disease and other unsuspected associated abnormalities.

Cardiac metastases.

The authors found metastases to the heart in 10.7% of 1029 autopsy cases in which a malignant neoplasm was diagnosed. The lung was the commonest primary site (36.4%) and adenocarcinoma was the most frequent cell type (36.4%) of neoplasms metastatic to heart. Nonepithelial tumors accounted for 22.7% of cardiac metastases. Epicardium was involved in 75.5% of metastatic lesions and a pericardial effusion was present with 33.7% of epicardial metastases. Although hemorrhagic effusions occurred in only 12 cases with metastases to heart, these represented 76.4% of all such effusions. Lymphomas associated with the acquired immune deficiency syndrome showed the most extensive cardiac involvement. Primary sites and cell types of cardiac metastases have evolved over time and have been modified by chemotherapy, increased survival of cancer patients, increasing incidence of lung carcinoma, and recently by the acquired immune deficiency syndrome epidemic.