Hodgkin's disease of the gastrointestinal tract.

Hodgkin's disease (HD) is rarely considered in the differential diagnosis of gastrointestinal (GI) disorders. We report eight cases of GI HD. The patients, ages 16-64, all with stage IV disease of varied histologic subtypes and GI symptoms including pain, upper or lower GI bleeding and/or obstruction. There was diffuse gastric fold thickening in one case, a large submucosal mass along the proximal greater curvature in another case, and a large ulcerating mass along the lesser curvature in the third case. Two cases of jejunal disease manifested as either a short or long segment of luminal narrowing with prominent mucosal nodularity. Another case exhibited a short area of complete mucosal destruction, irregular cavitation and intraluminal filling defect. In one additional case there was diffuse jejunal nodularity. Colonic involvement (two cases) presented as a solitary polypoid mass in transverse colon in one patient and severe narrowing of the descending colon with adjacent mesenteric mass on CT in another. We conclude that although rare in Hodgkin's disease, GI involvement should be considered, particularly in patients with stage IV disease.

Rectal cancer: extent of disease and radiotherapeutic effects by computed tomography.

The CT scans of 54 patients with carcinoma of the rectum were studied in an attempt to assess the value of computed tomography in the initial evaluation and therapeutic management of these patients. Thirty-five of the examined patients received full dose preoperative radiation therapy for sphincter preservation purposes, and had two or more computed tomography studies to delineate the progression of the disease and the response to radiotherapy. In 70% of these patients, changes in tumor size were demonstrated. Various aspects in the CT diagnosis of the primary or recurrent tumor extent, distant metastatic spread or involvement of surrounding tissues are discussed.

Iatrogenic esophageal-pleural fistula: subtlety of diagnosis in the absence of mediastinitis.

Seven patients with iatrogenic esophageal-pleural fistulas are described, and the differences in radiographic and physical findings in these patients and in patients with esophageal perforation with mediastinitis are emphasized. Radiographic findings in patients with esophageal pleural fistulas are pneumothorax, hydropneumothorax and localized pneumonitis. These fistulas can mimic other inflammatory supradiaphragmatic or infradiaphragmatic processes. Clinical and radiographic signs may be subtle, and active investigation is needed to establish the diagnosis of esophageal-pleural fistula in patients who have undergone esophageal manipulation.

Gastrointestinal radiologic manifestations of proximal spinal muscular atrophy (Kugelberg-Welander syndrome).

Proximal spinal muscular atrophy (Kugelberg-Welander syndrome) is a degenerating disease of the anterior horn cells of the spinal cord with atrophy of the proximal muscles resembling muscular dystrophy. The patient in this report exhibits radiographic features in the gastrointestinal tract similar to those seen in the muscular dystrophies, including myotonic dystrophy.

Esophageal manifestations of multisystem diseases.

The esophagus may be involved directly or indirectly by numerous disease conditions. On occasion, the esophageal process may be the key to the diagnosis. In some situations, the esophageal manifestation of a disease may be more immediately life-threatening than the primary process.

Transhepatic cholangiography.

Transhepatic cholangiograms were done on 81 patients. The Teflon sheath needle was used for 71 cases and the "Chiba" needle for ten. The "Chiba" needle transhepatic cholangiogram is recommended for the study of jaundiced patients with biliary duct dilatation, which is detected by ultrasound or computerized axial tomography.