Treatment of a patient with an infected hepatic cyst.

Symptomatic hepatic cysts are infrequently seen by family physicians. We review the literature and describe the diagnosis and management of a patient with cystic liver disease and a dominant infected hepatic cyst. The treatment included percutaneous drainage, intravenous antibiotic therapy, and sclerotherapy infusion using sterile alcohol (95% ethanol).

Small bowel perforation during enteroclysis.

Small bowel perforation with massive intraperitoneal leakage of barium occurred during the performance of enteroclysis in a 72-year-old woman. It is postulated that an ischemic segment of the partially obstructed ileum had ruptured because of rapid intraluminal flow of contrast material and increased abdominal pressure when the patient was rotated to a prone position.

Geophagia: an uncommon cause of acute abdomen.

Two cases of geophagia (dirt eating) that were diagnosed radiographically are presented. The clinical presentation mimicked urgent surgical conditions. The characteristic radiographic appearance provided a major clue to the correct diagnosis.

Post-traumatic splenic hematoma hidden by an overdistended stomach: use of nasogastric to avoid pitfalls.

The use of a nasogastric tube to empty the stomach contents prevents compression of the splenic parenchyma and allows clear visualization of the anterior medial border of the spleen and perisplenic area. Unsuspected superficial lacerations or a contained hematoma by the splenic capsule may become apparent only following this procedure. A representative case is reported.

Herpes esophagitis in immunocompetent patients.

Although herpes simplex virus is a recognized cause of esophagitis in immunocompromised patients, it may also be the etiologic agent in otherwise healthy individuals. Odynophagia and dysphagia are the major symptoms. The esophagogram may reveal ulcers in the distal esophagus and there may be motor disturbances as well.

Spigelian hernia.

The clinical diagnosis of Spigelian hernia can be difficult due to lack of specific and constant findings. We report two patients whose only symptoms on presentation were progressive abdominal pain and intermittent palpable mass. The radiographic demonstration of bowel extending outside the expected confines of the peritoneal cavity allowed prompt diagnosis and proper operative management in both patients.

Cholangiocarcinoma arising in a choledochal cyst: diagnostic value of computed tomography and ultrasonography.

A case of cholangiocarcinoma arising in a choledochal cyst (type II or biliary cyst in Alonso-Ley classification) in a 53-year-old woman is presented. Ultrasonography and computed tomography provided the correct preoperative diagnosis. The value of these modalities in presurgical planning is illustrated.

Malignant lymphoma in Hashimoto thyroiditis: CT appearance.

A case of malignant lymphoma arising in a patient with Hashimoto thyroiditis is presented. Computed tomography revealed a large, well encapsulated unilateral mass without adenopathy. The CT appearance in light of the clinical and laboratory data strongly suggested the diagnosis of lymphoma in favor of carcinoma.

Calcified rims. Uncommon radiologic finding and potential pitfall due to organization of deposits of oyster shell tablets.

In a patient undergoing double-contrast barium enema (DCBE) for evaluation of recent onset of diarrhea, a curvilinear strand of calcifications outlining a filling defect of the cecum, initially thought to represent a neoplasm, later was discovered to be due to precipitation and organization of orally ingested calcium in an adherent fecalith. Colonoscopy and repeated x-ray evaluation avoided the pitfall. This case illustrates the need for analysis and correlation of the type of calcifications characterizing a mass in light of the clinical history.

Seeding of malignant lymphoma along the tract after bone marrow biopsy.

A 74-year-old man with non-Hodgkin's lymphoma had seeding of tumor along the needle tract after bone marrow biopsy. This complication was recognized by computerized tomography.

Concurrent dissection and intracaval rupture of an abdominal aortic aneurysm: CT findings.

The CT findings of a concurrent dissection and intracaval fistula of an arteriosclerotic aortic aneurysm are reported. Recognition of the CT features of this severe and unusual complication is important for planning effective surgical treatment.

Real-time ultrasonography in the diagnosis of intussusception.

Adult intussusception may be difficult to detect. Clinical findings are variable and standard radiographic studies are not always helpful. In a patient with colocolic intussusception complicating carcinoma, the radiographic examination was normal and the definitive diagnosis was established by real-time ultrasonography alone.

Computed tomography in the evaluation of chest lesions in the pediatric patient.

The role of computed tomography (CT) in the management of chest masses in the pediatric patient is emphasized and illustrated. Thirty-seven patients with various chest lesions who had both CT and conventional radiologic evaluations are reviewed. CT was the most consistently accurate examination, especially in the evaluation of disease extent and relationship with other organs.

Carcinoma of the cervix: lymphangiography and computed tomography.

Twenty-four patients with carcinoma of the uterine cervix examined by lymphangiography followed by computed tomography (CT) were reviewed to assess the findings and their impact on management. The lymphangiogram was of value in detecting metastases in relatively small nodes, (less than 1.5 cm maximum diameter) and in differentiating metastases from reactive hyperplasia in the larger lymph nodes which were opacified.

Computed tomography in hepatic lymphoma.

Computed tomographic (CT) examinations of the abdomen, performed in 323 patients with lymphoma, were reviewed to determine the value of CT in detecting lymphomatous involvement of the liver and the CT appearance of hepatic lymphoma. Additionally, the CT scans were compared with the radionuclide scans. Of 95 patients in whom histological studies were performed, 65 had undergone both CT and radionuclide scanning.

Computed tomography in liposarcoma.

Seventeen cases with proven liposarcoma were evaluated by computed tomography (CT) to assess the specificity and value of this radiographic modality. A specific diagnosis of liposarcoma could be made in only four cases (22%). Despite its relative nonspecificity, CT proved extremely useful in the clinical evaluation of this tumor and evidenced considerable superiority to other radiographic methods.

Cranial computed tomography of malignant melanoma.

Two hundred seventy-five cranial computed tomography (CT) scans performed on 179 patients with malignant melanoma were reviewed. Of the 101 patients with confirmed cerebral metastases, CT demonstrated lesions in 93. In 72% of these, areas of increased attenuation were present in the precontrast scan.

Ultrasonographic patterns of hepatic lymphoma.

The hepatic sonograms of 443 patients with lymphoma were reviewed. Of these patients, 357 had nonHodgkin lymphoma, while 86 had Hodgkin disease. Sonography was able to detect disease in 5.

The striped colon: a new radiographic observation in metastatic serosal implants.

Forty-five patients with metastatic serosal implants to the colon were reviewed. The radiographic findings as well as a distinct sign, "the striped colon" are described. The presence of that sign might be the only finding in patients with colon metastases, studied by air-contrast barium enema examination.

Absence of hepatic segment of the inferior vena cava with azygous continuation.

One patient with infrahepatic interruption of the inferior vena cava with azygous continuation was examined by computed tomography (CT) and inferior venacavography. The characteristic CT findings are discussed and correlated with venacavography.

Computed tomography in the evaluation of small round cell tumors of bone.

The value of computed tomography (CT) in the management of 20 cases of round cell tumors of bone is reported. CT is useful in: (a) early diagnosis, particularly incomplex anatomical areas; (b) the evaluation of the extent of disease; (c) the determination of the radiation portals; (d) the evaluation of the response to therapy; and (e) the preoperative evaluation of those tumors removed surgically. In comparison with other radiographic modalities, CT was equally accurate in six and more accurate in 10 patients.