Percutaneous angioplasty in clinical management of renovascular hypertension: initial and long-term results.

Between January 1980 and July 1983, percutaneous transluminal angioplasty was attempted on 137 stenotic renal arteries in 100 patients. At termination of follow-up studies (3-39 months, mean of 16 months), 70% of those treated for hypertension had benefited from the procedure. Stenosis secondary to fibromuscular dysplasia responded better than stenosis from arteriosclerosis (85% and 65% of the patients, respectively).

Portaprival collaterals following distal splenorenal shunt. Incidence, magnitude and associated portal perfusion changes.

Collateral venous pathways develop between the high pressure portal vein and low pressure splenic vein following distal splenorenal shunt. This review of angiography in 50 patients with cirrhosis prior to and 1 year after DSRS shows that 98% developed collaterals: 72% transpancreatic, 48% transgastric, and 46% colonic. Multiple pathways developed in 64% of patients.

Varices from portal hypertension: correlation of CT and angiography.

Two hundred abdominal CT and angiographic examinations were performed on 137 patients with portal hypertension. These patients were being evaluated before or after a distal splenorenal shunt. CT increased the detection of umbilical and retroperitoneal varices.

Restoration of portal venous perfusion and reversal of encephalopathy by balloon occlusion of portal systemic shunt.

Operative ligation of total portasystemic shunts is effective in reversing hepatic encephalopathy but is associated with significant mortality. In the case reported, invasive radiographic techniques were used to occlude a mesorenal shunt and reverse recurrent, disabling encephalopathy in a 72-yr-old woman. Occlusion of the shunt, coupled with coronary vein embolization, improved angiographic portal perfusion from grade IV to grade I, increased nutrient liver blood flow from 577 ml/min to 848 ml/min, and increased the hepatic fraction of cardiac output from 8.

The computed tomography-guided adrenal biopsy. An alternative to surgery in adrenal mass diagnosis.

A series of 16 patients with adrenal masses were biopsied percutaneously under computed tomography (CT) guidance with 18- to 22-gauge modified Chiba needles. Adrenal adenomas, cysts, metastases, melanoma, and adrenal hemorrhage were identified. Of nine oncologic patients, four had adrenal metastases, while five had other nonmalignant adrenal masses.

Varicoceles: a coaxial coil occlusion system.

A modified transfemoral technique for testicular venography and occlusion of the testicular vein (TV) was used to treat 30 patients with a total of 43 varicoceles (17 left-sided and 13 bilateral). Occlusion was satisfactory in all left varicoceles and 90% of right varicoceles. This coaxial technique facilitates subselective catheterization of the TV and its collaterals and enables coils to be placed deep within these vessels, either alone or in combination with detachable balloons.

Percutaneous drainage of multiseptated hepatic abscess.

Thirteen patients with multiseptated, hepatic abscesses were initially treated by percutaneous drainage using computed tomographic guidance. One of these 13 patients required surgery because of failure of percutaneous drainage due to the viscosity of the debris within the multiseptated cavities. Another patient required a second percutaneous drainage procedure due to recurrent hepatic fluid collection.

Percutaneous drainage of abdominal abscesses.

Abdominal abscesses carry high morbidity and mortality unless properly drained. In recent years, percutaneous drainage has become an accepted alternative to surgery. A brief overview of diagnostic principles, selection of patients, percutaneous drainage catheters and technique, contraindications, and post-drainage follow-up is presented.

CT directed hepatic biopsies: increased diagnostic accuracy with low patient risk.

A technique for computed tomography directed percutaneous liver biopsy using small gauge (18-20) needles is described. In 51 procedures performed on 50 patients tissue specimens adequate for diagnosis were obtained 49 times (96%). There was one false negative diagnosis.

Multiple NMR T2 relaxation values in human liver tissue.

Twenty-one human hepatic liver biopsy samples were evaluated by nuclear magnetic resonance spectroscopy. This spectroscopy was performed by obtaining multiple and not single T2 values (T2-long and T2-short). Neoplastic tissue had greater T2-long and T2-short values than diffuse liver disease.

Monitoring the response of lymphoma patients to therapy: correlation of abdominal CT findings with clinical course and histologic cell type.

A review was made of 365 abdominal computed tomographic (CT) examinations in 125 patients with a histologic diagnosis of lymphoma who had undergone CT before and after therapy. Clinical correlation immediately preceding the follow-up CT examination was obtained in 100 patients. In these 100 patients, five distinct subgroups emerged: (a) reduction in extent of disease without changes in internal nodal characteristics; (b) reduction in extent of disease with change in internal nodal characteristics; (c) no change in extent of disease and no change in internal nodal characteristics; (d) no change in extent of disease but change in internal nodal characteristics; and (e) disease progression.

Biopsy of the right adrenal gland by the transhepatic approach.

A transhepatic computed-tomographic-guided biopsy of a right adrenal mass is described. This method is simpler to perform than the usual posterior biopsy carried out with the patient prone and is less likely to cause a complicating pneumothorax. In seven of eight patients with right adrenal masses, adrenal tissue was obtained and an accurate diagnosis was possible.

Management of stenosis of distal splenorenal shunt by balloon dilation.

Stenosis of a distal splenorenal shunt may lead to inadequate variceal decompression with the risk of rebleeding. We report this complication in three patients at five, 16 and 17 months after DSRS, with successful management by balloon dilation. One patient had rebled from varices and the other two showed roentgenologic evidence of inadequate variceal decompression.

Effectiveness of CT in evaluating intrathoracic masses.

To compare the effectiveness of computed tomography (CT) with conventional radiography and conventional tomography for evaluating masses in the thorax, 168 masses, 154 of which were histologically verified, which had been examined with CT were reviewed. In 74 instances (44%) CT provided important additional information compared with conventional radiography. Compared to conventional tomography, CT added important information in 15 (23%) of 65 cases.

The incidence and natural history of thrombus in the portal vein following distal splenorenal shunt.

The incidence of thrombus formation in the portal vein following distal splenorenal shunt was 4% occlusive and 14% nonocclusive from 1974 to 1977, and 6% occlusive and 22% nonocclusive in 1980. The increased incidence was probably due to more aggressive ligation of collaterals on the portal vein. Ten patients with this complication were evaluated prospectively with clinical and biochemical parameters, angiography, and nutrient hepatic perfusion.

Liver lesions: comparative accuracy of scintigraphy and computed tomography.

Of 84 cases with both radionuclide and computed tomographic studies of the liver, in 54 the results of the two examinations agreed, in 14 results disagreed, and in 16 cases one of the two tests gave equivocal results. Overall accuracy in detecting or ruling out focal liver disease was 79% for scintigraphy and 98% for computed tomography. In 13 of the 14 patients in whom studies did not agree, the scintigram was falsely negative.

Gas in the pancreatic bed without abscess.

A series of 259 patients from the Emory University Affiliated Hospitals with clinical suspicion of pancreatic inflammatory or neoplastic disease was reviewed. Seven of the patients had documented gas in a pancreatic mass; three of the cases were proved subsequently not to be pancreatic abscess formation. Two of the seven patients had proven fistulae from pseudocyst to bowel documented either by surgery or on an associated radiologic examination which accounted for the gas.

Arthroscopy and arthrography of the knee: a comparison study.

Between 1975 and 1978, over 200 knee arthroscopies were performed at the Emory University Hospitals; the findings were totally correct in 91%. During the same period, arthrograms were performed on 79 different patients, 39 of whom had confirming arthrotomies. The arthrograms were totally correct in 38%.

Hepatic focal nodular hyperplasia: angiography, CT, sonography, and scintigraphy.

Eleven patients with focal nodular hyperplasia of the liver underwent a combination of radiologic procedures, including sonography, computed tomography (CT), hepatic scintigraphy, and angiography. This paper describes the radiologic findings in this group of patients and reviews the current literature. In the present series, sonography was the most sensitive (100%) method for detection of focal nodular hyperplasia, while CT was able to detect only seven (78%) of nine cases.