Radionuclide-guided balloon occlusion pulmonary cineangiography: an adjunct to pulmonary arteriography.

Fifty-eight patients, 38 of whom had pulmonary emboli, were evaluated for pulmonary occlusive disease with flow-directed balloon occlusion pulmonary cineangiography. Areas studied were selected by radionuclide perfusion lung scans and indeterminant areas of pulmonary occlusion were imaged on standard catheter pulmonary magnification cut films. In 4 of 38 patients, the balloon occlusion technique demonstrated peripheral pulmonary emboli not seen on standard pulmonary arteriography. Selective flow-directed balloon occlusion pulmonary cineangiography is an effective adjunct for evaluating some patients with pulmonary emboli.

Angiography of pulmonary emboli: digital studies and balloon-occlusion cineangiography.

The value of digital pulmonary arteriography and balloon-occlusion cineangiography was investigated in 118 selected patients. In one series of 40 patients, digital pulmonary arteriography correctly identified pulmonary emboli in 20 (75%) of 26 positive examinations when interpretation was confined to the first three divisions of the pulmonary artery. In a second series of 78 patients with peripheral radionuclide perfusion scan defects, 40 of whom had pulmonary emboli, adjunctive balloon-occlusion cineangiography demonstrated emboli in four patients not seen on standard selective catheter pulmonary magnification studies with cut films. These two procedures (i.e., digital pulmonary arteriography and balloon-occlusion cineangiography) are important adjuncts to radionuclide perfusion scans and selective catheter pulmonary arteriography in the evaluation of patients with pulmonary emboli.

May-Thurner syndrome.

Three patients with long standing edema of the left leg were examined, and venography and hemodynamic studies were performed. All three patients had a "spur" (May-Thurner syndrome) of the left common iliac vein at the level of the crossover position of the right common iliac artery. Surgical exploration in two of these patients verified marked hypertrophy of the intima of the left common iliac vein that caused partial obstruction. Surgical repair resulted in great improvement. Anatomic findings at venography are characteristic of this syndrome. Hemodynamic pressure measurements are of ancillary help in confirming the diagnosis.

Emergency arteriography in extremity trauma: assessment of indications.

Two hundred and four cases of extremity trauma were evaluated. Arteriography was performed in 70 patients for one or a combination of the following indications: absent or diminished pulse, proximity to a major vessel, enlarging or significant hematoma, neurologic deficit, fracture or dislocation, or systemic hypotension. Of the 70 patients, 37 (53%) demonstrated positive arteriographic findings; the most common was arterial occlusion. Patients with an absent or diminished pulse, the most reliable indicator of arterial injury, should have immediate arteriography. Patients who have strong and equal peripheral pulses and are clinically stable should be observed and undergo elective arteriography. Three patients with intimal injuries had intact pulses, but no pattern of indications was helpful in identifying these injuries. A combination of indications is indicative of more serious injury and more likely to produce a positive arteriographic study.

Neonatal diagnosis, treatment and related factors of congenital dislocation of the hip.

The unstable hip can be diagnosed in newborns with acceptable accuracy. The following factors are associated with the newborn unstable hip: female preponderance, breech presentations, cesarean section deliveries, first borns, left hip involvement, the Caucasian race, and increased birth weight. These findings suggest that the newborn unstable hip is determined prior to delivery, possibly within the last 4 weeks of intrauterine life. Diagnosed at birth, treatment in the average case is relatively short-term, effective, and without complication.