Echographic and radionuclide detection of hepatoma.

The clinical, echographic, radionuclide and CT studies of 19 patients with tissue-proved hepatoma were reviewed retrospectively. All patients had undergone ultrasound examination while 18 also had 99mTc-sulfur colloid studies, and 11 had gallium scans. Ultrasonically, the lesions were classified as discrete, sonodense (six cases), discrete sonolucent (five cases), disorganized hepatic parenchyma (six cases), and normal parenchyma (two cases). All sulfur colloid studies showed areas of decreased uptake, while all gallium scans showed relative increased uptake in the area of decreased sulfur colloid activity. It was concluded that radionuclide imaging is more accurate than ultrasound in the diagnosis of hepatome.

Transpyloric extension of gastric carcinoma.

Transpyloric extension of gastric carcinoma occurred in 17 (20%) of 88 patients with gastric carcinoma. In the majority of cases, this was a microscopic phenomenon, but in 7 patients with gastric carcinoma there were gross changes in the duodenum which were reflected in the upper-gastrointestinal series. Contrary to general opinion, transpyloric extension of gastric carcinoma is not a rare finding.

Comparison of barium enema nad colonoscopy in the detection of small colonic polyps.

A total of 210 patients was examined by barium enema and colonoscopy. The authors found 219 polyps in 112 patients. Single-contrast barium enema missed 33 (45.2%) and double-contrast barium enema missed 17 (11.7%) polyps. Colonoscopy failed to detect 6 polyps (2.7%) and another 21 (10%) were not seen because the area could not be reached by the colonoscope. Malignancy was present in 5 small polyps. The authors conclude that the double-contrast barium enema offers a definite advantage in the right colon. In general, the two methods are complementary.

Intraabdominal calcification in treated disseminated carcinoma of the ovary.

The presence of diffuse abdominal calcification in patients with known carcinoma is usually a sign of metastatic involvement. This finding in some patients who have been treated with high dosage radiation therapy may represent areas of tumor necrosis and subsequent healing without evidence of active malignancy.

Hepatic excretion of cholecystopaques introduced into the canine jejunum.

The biliary excretion of five oral cholecystopaques was measured following their introduction into the jejunum of bile fistula dogs. The mean maximal iodine concentration in the bile ranged form a low of 2.2 +/- 0.55 mg per ml following a dose of 33 mg of iodine per kg of iopanoic acid to a high of 12.9 +/- 1.4 mg per ml after the same dose of sodium ipodate. Cumulative excretion at the end of three hours was over five times greater with sodium ipodate in comparison to ipoanoic acid. It is felt that the best explanation of this date is the ability of the more water soluble media to pass through the unstirred water layer of the intestine.

The bile ducts.

The common duct is a critical conduit. Hippocrates observed that to maintain health it is important to keep the yellow bile from the liver in balance. The present authors provide extensive descriptions of the structure, function, anomalies and disorders of the bile ducts, and make special note of the radiographic techniques available for use in diagnosis.

Pneumoperitoneum: importance of right upper quadrant features.

Supine abdominal radiographs of 59 patients with documented pneumoperitoneum were evaluated for findings of pneumoperitoneum. The commonly described signs were seen in only 17%. Localized intraperitoneal air in the right upper quadrant was the most frequent finding, seen in 49% of patients. Identification of these collections of air is dependent upon knowledge of the anatomy of the perihepatic spaces.

Ureteral changes in Gardner's syndrome simulating retroperitoneal fibrosis.

The development of desmoid tumors in patients with Gardner's syndrome may produce ureteral findings on excretory urogram which, by themselves, are indistinguishable from other causes of retroperitoneal fibrosis.

Colonic changes of herpes zoster.

The lesions of herpes zoster of the colon were observed in three cases. Small polygonal mucosal blebs or small ulcerations involving a short segment of the colon and appearing in a reasonable time relationship with the cutaneous manifestations either in a corresponding or noncorresponding dermatome should enable diagnosis of this unusual condition. Recognition of this entity in the presence of these skin lesions should be obvious and therefore helpful in avoiding more aggressive and invasive diagnostic procedures.

Plain film findings of gastric volvulus herniating into the chest.

When confronted with a chest radiograph demonstrating two large air-fluid levels, one in the retrocardiac mediastinum and the other beneath the left hemidiaphragm, the possibility of gastric volvulus herniating into the thorax should be strongly considered. These patients should have an immediate contrast study for further evaluation.

Vascular impressions of the gut secondary to chronic vascular occlusive disease.

Clinical diagnosis of chronic vascular occlusive disease is difficult since symptoms are often vague. The presence of discrete extrinsic contoural defects along the medial aspect of the descending duodenum or proximal small bowel is a useful diagnostic feature in such patients. Five of eight patients with chronic vascular occlusion who had examination of the upper gastrointestinal tract demonstrated this finding. If presented with this radiographic observation on barium study, visceral arteriography should then be considered.

Gastric lymphoma, a radiologic diagnosis.

Because endoscopy and gastric cytology lack specificity, radiographic evaluation is still the most reliable means of diagnosing gastric lymphoma preoperatively. A retrospective analysis indicates that if careful attention is paid to the radiologic features, gastric lymphoma can be distinguished from gastric carcinoma in most of cases. The radiographic findings of a long segment of involvement, multiplicity of radiographic pattern, and diffuse infiltration consisting of concentric abnormal folds without significant narrowing of the lumen are characteristic of the non-Hodgkin's lymphoma.

Abdominal desmoid masses in Gardner's syndrome.

Abdominal masses, "desmoid tumors," occur in approximately 4% of patients with Gardner's Syndrome, usually 1--3 years after total colectomy. Histologic sections usually resemble those of an infiltrating fibrous tumour, a desmoid lesion. The radiographic pattern may be similar to any diffuse abdominal retroperitoneal tumor, metastatic disease, lymphoma, or possibly retractile mesenteritis. The clinical setting usually differentiates these entities.

Metastatic disease involving the stomach.

Metastatic disease involving the stomach is an unusual and difficult clinical problem. A review of 1010 autopsies of patients with cancer disclosed 17 cases of gastric metastases (an incidence of 1.7%), with breast cancer, lung cancer, and melanoma being the most frequent primaries. The clinical manifestations of epigastric pain, melena, and anemia are nonspecific, necessitating radiographic examination of the gastrointestinal tract. The radiographic findings are usually sufficient to suggest the diagnosis.