Failure to detect extramedullary hematopoiesis during bone-marrow imaging with indium-111 or technetium-99m sulfur colloid.

A patient with postpolycythemic myeloid metaplasia developed an enlarging abdominal mass documented on TCT scanning. To distinguish between lymphoma and extramedullary hematopoiesis, marrow elements were imaged with indium-111 chloride and technetium-99m sulfur colloid. Because the mass failed to accumulate either tracer, a presumptive diagnosis of lymphoma was made and exploratory surgery was performed. The excised mass was found to consist of enlarged lymph nodes containing extramedullary hematopoiesis. Caution should be exercised in the use of In-111 or Tc-99m SC bone-marrow scans to diagnose sites of extramedullary hematopoiesis.

Air as an ultrasound contrast marker for accurate determination of needle placement. Tumor biopsy localization and other applications.

Computed tomography (CT) and ultrasonography can be performed to localize tumors for percutaneous biopsy. With CT, the biopsy needle can be visualized within the sample volume. The needle can not be seen within the tumor on B-scan ultrasound images. The authors have devised an air contrast technique to determine the location of the needle tip and the biopsy site. This technique can also be used for organ biopsies.

Gas as a contrast agent and diagnostic aid in abdominal sonography.

Gas has a characteristic ultrasound pattern, usually recognized as an area of focal dense echogenicity with acoustic shadowing. It often contains reverberation echoes. Sonographers should be familiar with this pattern and should suspect underlying disease when gas is demonstrated in abnormal or unusual locations. The authors have collected 18 cases; four representative cases are presented to illustrate this principle.

Fetal elevation: a new technique for placental localization in the diagnosis of previa.

The diagnosis of previa is made with ultrasound when the placenta is seen to cover the internal os. The technique of fetal elevation is a simple procedure that facilitates visualization of the internal os and its relation to the placenta. The safety of this technique is demonstrated in a large series of patients.

Ultrasound air contrast transfusion technique: an aid to managing the Rh-affected fetus with ascites.

The successful management of an Rh-sensitized pregnant patient is reported in whom fetal intrauterine transfusions were utilized despite the presence of fetal ascites before the 26th week of gestation. A new ultrasound air contrast technique is described that confirms the correct intraabdominal placement of the transfused blood. The technique is not dependent on the amount of blood introduced, nor is it masked by fetal ascites.

Differential diagnosis of lateral orbital masses.

Computed tomography is ideal for demonstrating orbital masses. It provides information regarding lesion location and involvement of intraorbital structures. It therefore can be used in both staging and follow-up of orbital lesions. Mass location, attenuation characteristics, form, and presence or absence of contrast enhancement all may aid the radiologist in the differential diagnosis of orbital lesions by CT. However, this review of lateral orbital masses illustrates that the differential diagnosis can be quite varied. Careful correlation with history and clinical findings may lead one to the proper diagnosis; however, often the exact nature of a lateral orbital mass must await histologic confirmation.

Air as a contrast marker for ultrasound-guided fetal transfusions.

The authors describe a new air contrast technique for B-scan ultrasound to confirm the correct intra-abdominal placement of transfused blood after nine intrauterine transfusions in four patients. Such confirmation by this method is neither dependent on the amount of blood introduced nor masked by fetal ascites.

Diagnosis of abdominal abscesses with computed tomography, ultrasound, and 111In leukocyte scans.

Computed tomography (CT), ultrasound, and 111In-labeled leukocyte scans are all used in the evaluation of abdominal abscesses. In this study, 170 patients in whom one, two, or all three of these modalities were used retrospectively reviewed. Diagnostic accuracy of 96% for CT, 90% for ultrasound, and 92% for 111In leukocyte scans was achieved. It was often necessary to use more than one modality to arrive at a correct diagnosis. The advantages and disadvantages as well as the causes for false positive or false negative interpretations of each of these modalities are reviewed. Analysis of the different examinations resulted in a suggested sequence by which patients can be examined, based upon their clinical condition. Patients who are not critically ill and/or who have no localizing signs should be studied first with 111In-labeled leukocyte scans. If, however, localizing signs should or the patient's condition necessitates prompt intervention, CT or ultrasound should be the first study performed.

Computed tomography in the evaluation of abdominal abscesses.

Review of experience using computed tomography in 50 patients with a suspected diagnosis of abscess indicated it to be accurate and reliable. Most abscesses were sharply demarcated masses. After intravenous injection of contrast medium, the rim was enhanced in about 35 percent of the patients. In six patients the inflammatory mass had ill-defined borders. It is concluded that when the computed tomographic findings are correlated with clinical history, the correct diagnosis can almost always be reached. If surgery is not contemplated, computed tomography or ultrasound-guided needle aspiration should be performed to confirm the diagnosis.

Ultrasound as a diagnostic aid in the evaluation of popliteal swelling.

Ultrasound (US), because of its ability to distinguish cystic from solid tissue, is an ideal tool for diagnosing masses in the popliteal fossa. Five cases are presented. Two cases show the typical ultrasound images in the most common popliteal mass, a cyst. A third case significantly points out the necessity of further investigations if the US findings are atypical of a simple cyst and the patient is symptomatic. A fourth case demonstrates that the US image can distinguish an aneurysm of the popliteal artery from a cyst. A fifth case demonstrates that a solid tumor in the popliteal fossa, in contrast to that of a cyst, has a characteristic US image. Ultrasound is a simple, quick, noninvasive outpatient procedure available to almost every physician. In most instances, US appears to be the diagnostic procedure of choice following conventional radiography in the evaluation of swelling in the popliteal fossa.

The value of B-scan ultrasound following intrauterine fetal transfusion.

B-scan ultrasound performed in 6 patients for a total of 15 intrauterine fetal transfusions provided quick, easy, and reliable confirmation of the fetal intra-abdominal placement of transfused blood.

Need for chest radiographs during and after lymphography.

Retrospective review of 100 lymphograms showed that routine chest radiography after injection of the lymphographic contrast medium and follow-up films 24-48 hr later yielded no clinically useful information. It was concluded that routine postlymphography chest radiography is not necessary and should be reserved for patients in whom complications are suspected.