Hepatic hemangioma with normal angiograms. Three case reports.

Three cases of symptomatic cavernous hemangioma of the liver are reported. All three patients have normal angiograms. A review of the literature shows that the diagnosis of hemangioma may be made noninvasively with a high degree of accuracy. Technetium Tc 99m-labeled red blood cell scanning is very specific, while dynamic computed tomography may be more sensitive for small lesions. A combination of the two modalities makes the diagnosis in greater than 90% of cases. Magnetic resonance imaging is also sensitive and specific. Angiography, as shown in these cases, may not only be questionably indicated, but may be misleading. The treatment for symptomatic lesions is resection, and secondary alternatives are discussed.

The role of intravenous digital subtraction angiography in the evaluation of extracranial carotid artery disease. Can the decision for carotid artery surgery be made solely on the basis of its findings?

This retrospective study compared intravenous digital subtraction angiography (IV-DSA) with conventional catheter angiography (CA) performed on 105 patients with suspected cerebrovascular disease. Comparisons were made considering CA as the "gold standard." Factors reviewed for correlation included carotid artery stenosis, ulceration, fibromuscular disease, vessel occlusion, and subclavian and intracranial lesions. Each IV-DSA was judged as to its quality. Eighty-seven patients (83%) had interpretable IV-DSA studies. IV-DSA differed from CA regarding stenosis on 46 carotid arteries (26%). Of 47 excellent quality IV-DSA studies, 18 (38%) were in disagreement with CA regarding stenosis. For the subcategory of patients having hemodynamically significant stenosis (greater than 50% luminal narrowing) according to CA, the sensitivity of IV-DSA was 85%. Specificity was 94% with an overall accuracy rate of 92%. The authors believe these high values are somewhat misleading. The IV-DSA interpretation of stenosis differed from CA in 32 of 48 patients (67%) in this group with a mean difference of 30%. IV-DSA identified 3 of 11 intracranial lesions (27%). Surgical therapy was modified in 13 of 87 patients (15%) on the basis of angiographic interpretation of carotid artery stenosis compared with IV-DSA. We conclude that IV-DSA should be used as a screening tool and the decision for carotid artery surgery made solely on its findings should be reached with the knowledge of its limitations and that any patient with hemispheric cerebral symptoms warrants CA as the first diagnostic examination.

The correlation between surgical and CT estimates of brain damage following missile wounds.

The occurrence of distant brain damage following an apparent focal missile injury to the brain has not been well documented until computerized tomography scanning demonstrated this phenomenon. Mechanisms of additional or distant damage within the brain may include a high deposit of kinetic energy from the penetrating missile, additional vascular damage, and possibly neuronal and axonal degeneration. Widespread and distant brain changes may explain some instances of late neuropsychological and psychiatric dysfunction or rehabilitation failure following a brain wound. Brain imaging should be used to properly evaluate the full extent of brain damage following wounding.

Evaluation of parathyroid adenomas by intravenous digital subtraction angiography.

Intravenous digital subtraction angiography (DSA) successfully localized three previously suspected parathyroid adenomas in the lower part of the neck and one in the mediastinum. Our experience suggests that this method may have widespread application for preoperative evaluation of parathyroid adenomas, particularly after unsuccessful surgical exploration or when recurrent or ectopically located adenomas are likely. In three other cases abnormal vascular blushes in the neck on intravenous DSA were related to thyroid disease. Close correlation with the clinical and laboratory findings is necessary to avoid potential pitfalls in diagnosis.

Computed tomography of deep cerebral venous thrombosis in children.

Three cases of deep cerebral venous thrombosis in children are presented, and the cranial computed tomographic (CT) findings and angiographic findings reviewed. Two patients had findings indicative of brain death at the time of initial CT examination. The third patient recovered without neurological sequelae. Noncontrast-enhanced CT examinations showed abnormally dense-appearing deep venous structures, mimicking a contrast-enhanced study. On the arteriogram the deep venous system failed to opacify, and multiple collaterals to the superficial venous system were formed.

Angiodysplasia of the colon.

Angiodysplasia of the colon was diagnosed by arteriography in 33 patients. Approximately one fourth of the lesions were located in the left side of the colon. Three patients with sigmoid lesions had a second lesion elsewhere in the gastrointestinal tract. The lesions on the left involved a more extensive segment of bowel than those on the right. Almost one third of the patients were younger than 60, and 2 were in their thirties. The angiodysplasia is the source of the bleeding in most patients, and its resection results in cure.