Prebiopsy wire localization of a small peripheral lung nodule.

The authors report a case in which metallic microcoils were placed under computed tomographic guidance as wire localization devices prior to an excisional lung biopsy. The technique and advantages are somewhat analogous to those of pre-excisional biopsy of a breast mass with use of wire localization performed under mammographic guidance. This technique was useful for localizing the mass as well as limiting the amount of surgically excised tissue in this case. Additionally, the postexcision specimen radiograph helped confirm that the lung lesion in question had been removed. This may be a useful preoperative technique prior to excisional biopsies of small lung lesions that may not be accessible with percutaneous biopsy techniques and in selected cases such as in patients with diseased lung parenchyma surrounding a lesion or in patients in whom the lesion to be excised is adjacent to the pulmonary root.

Use of metallic stents to salvage and maintain patency in surgically created esophagocutaneous fistulas.

The authors report a case in which metallic Gianturco-Rosch stents were used to maintain patency of a surgically created cervical esophagocutaneous fistula. The patient was a young man with a schizoaffective disorder who underwent esophagogastrectomy as a result of multiple suicide attempts with lye ingestion. Surgical reconstruction was not possible due to extensive tissue damage. A surgically created cervical esophagocutaneous fistula allowed drainage of oral secretions but subsequently closed. Metallic Gianturco-Rosch stents were successfully used to maintain patency of this fistulous tract, following balloon dilation of the scarred hypopharynx and the tract, which has remained functional for 10 months.

Evaluation of contrast dose reduction for excretory urography using computed radiography.

We prospectively investigated whether performing excretory urography by computed radiography (CR) - with CR's broader dynamic range and potential for post-processing - would permit lower contrast dose while maintaining usual image quality. The rationale for this experiment was to evaluate whether CR had potential in reducing the risks and costs associated with urography. Sixty sequential patients were randomly assigned to undergo computed urography with either our full (282 mg I/kg body weight) or half our usual dose (141 mg I/kg body weight) of intravenous 60% diatrizoate meglumine. Three blinded observers judged automatically post-processed full dose tomograms and KUBs as qualitatively superior to both automatically post-processed and individually, interactively post-processed half dose images. Thus, post-acquisition image manipulation could not fully compensate for diminished image quality due to contrast dose reduction.