Intramural and intraperitoneal hemorrhage due to duodenal ulcer.
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Aged↗
Biomedical subjects
D R Radin
Publications and source records attributed to D R Radin.
Disseminated histoplasmosis: abdominal CT findings in 16 patients.
Since the onset of the AIDS epidemic, disseminated Histoplasma capsulatum infection has been reported with much greater frequency in both endemic and nonendemic areas. Abdominal CT scans of 16 patients with disseminated histoplasmosis were reviewed retrospectively to identify radiologic features of this disease. The diagnosis was confirmed by autopsy (three patients), bone marrow biopsy (10 patients), lymph node biopsy (three patients), bronchoscopic biopsy (three patients), liver biopsy (two patients), and/or colonoscopic biopsy (one patient). Fourteen patients had serologic evidence of human immunodeficiency virus infection. Disseminated histoplasmosis was either the only initial manifestation of AIDS (seven patients) or was accompanied simultaneously by cytomegalovirus infection (four patients), or Kaposi sarcoma, Toxoplasma encephalitis, or cryptosporidiosis (one patient each). Abdominal CT findings included hepatomegaly (63%); splenomegaly (38%); diffuse splenic hypottenuation (19%); bilateral adrenal enlargement or hypoattenuating masses (13%); and enlarged lymph nodes with homogeneous soft-tissue density (44%), diffuse or central low density (13%), or both (19%). Histoplasmosis should be included in the differential diagnosis when abdominal CT scans show such nonspecific findings as hepatomegaly, splenomegaly, enlarged soft-tissue-density or hypoattenuating lymph nodes, or adrenal enlargement or masses in an immunodeficient patient. An uncommon but possibly specific CT finding in histoplasmosis is diffuse splenic hypoattenuation.
Acquired Immunodeficiency Syndrome↗
Color Doppler sonography in hepatocellular carcinoma.
Sixteen patients with hepatocellular carcinoma (HCC) were assessed with color Doppler sonography (CDS) for flow compared to normal hepatic parenchyma. Nine showed moderate increased flow, and two revealed marked increased flow. In most instances, the increased flow was peripheral. Color Doppler was also useful in assessing seven patients with portal vein invasion. In two instances, venous invasion was not detected on preliminary grayscale images. In another patient, hepatic venous invasion was suspected on grayscale images, but was shown to represent extrinsic compression only by color Doppler.
Carcinoma, Hepatocellular↗
Carcinoma of the cystic duct.
Two patients with carcinoma of the cystic duct presented with obstructive jaundice due to extrinsic compression of the common hepatic duct by the tumor. Sonography and computed tomography showed dilatation of the intrahepatic bile ducts and gallbladder. In one patient, a calculus seen in the gallbladder neck suggested Mirizzi syndrome. In the other, a small soft tissue mass was indistinguishable from a common duct tumor or an enlarged lymph node. In both cases, direct cholangiography demonstrated extrinsic compression and displacement of the common duct with proximal biliary dilatation and nonvisualization of the gallbladder. Carcinoma of the cystic duct should be considered whenever there is evidence of cystic duct obstruction and/or when cholangiography shows extrinsic mass effect on the common duct.
Bile Duct Neoplasms↗
Visceral and nodal calcification in patients with AIDS-related Pneumocystis carinii infection.
Clinical and radiologic findings in nine patients with AIDS and disseminated Pneumocystis carinii infection were analyzed retrospectively. The diagnosis was confirmed by autopsy (five patients) and by biopsy (two patients). All nine had a history of P. carinii pneumonia. CT showed parenchymal calcifications in the spleen (seven patients), liver (six patients), kidneys (six patients), abdominal lymph nodes (three patients), adrenal glands (two patients), and mediastinal lymph nodes (one patient). Multiple punctate calcifications in the liver, spleen, kidneys, and/or adrenal glands were visible on plain films in three patients. Sonography showed diffuse tiny echogenic foci without shadowing in the liver, spleen, and kidneys. In one patient, CT showed multiple hypodense lesions in the spleen. P. carinii infection should be included in the differential diagnosis when calcifications or focal lesions are detected at one or more extrapulmonary sites in an immunodeficient patient, even if there is no history or evidence of P. carinii pneumonia.
Acquired Immunodeficiency Syndrome↗
A patient with a retrohepatic gallbladder.
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Cholecystography↗
Compression of pulmonary artery by syphilitic thoracic aortic aneurysm: imaging.
A case of syphilitic aortitis with multiple thoracic aneurysms, one of which caused compression of the left pulmonary artery with hypoperfusion of the left lung as seen with perfusion scintigraphy, blood pool studies, CT, and magnetic resonance imaging is presented.
Aorta, Thoracic↗
Radionuclide angiography in suspected acute cholecystitis: further observations.
Radionuclide angiography (RNA) and cholescintigraphy were performed prospectively in 300 patients with suspected acute cholecystitis (AC). Of 79 patients with positive RNA, 63 had AC (80%). Positive RNA was seen in 23 of 26 cases with gangrenous AC (88%) while 12 of the 26 had a positive "rim" sign (46%). All 12 patients with a positive "rim" sign had positive RNA. The "rim" sign may be caused by increased perfusion. Five of 6 patients with positive RNA and "obstructive" pattern had AC (83%). Patients with negative RNA and positive cholescintigraphy had a positive predictive value of 54% (31/57), while those with positive RNA and positive cholescintigraphy had a positive predictive value of 85% (57/67). RNA showed increased perfusion to nonbiliary pathology such as liver abscesses and pyelonephritis. Positive RNA increases the predictive value of cholescintigraphy and may be useful to shorten cholescintigraphic examinations.
Adult↗
FM sonography in gallbladder disease: efficacy and comparison with conventional sonography.
A new type of ultrasound signal processing ("FM sonography") appears to be beneficial compared to conventional ultrasound ("AM sonography") in some applications (e.g., diffuse liver disease and prostatic carcinoma). Despite these possible advantages, it is doubtful FM sonography will be widely used unless it is at least as useful as conventional (AM) sonography in all common applications. Fifty-five patients with suspected gallbladder disease were independently evaluated with both AM and FM sonography. The two modalities were blindly and prospectively compared for accuracy in detecting gallstones and for image quality. No statistically significant difference was found between images produced by FM and conventional signal processing. FM had an accuracy of detecting gallstones of 98.1%, compared to 96.2% for AM. Overall, FM accuracy was 97.7%, while AM had an overall accuracy of 97.3%. Other useful sonographic signs were evaluated (gallbladder wall thickness, diameter of common duct). No AM/FM difference was noted. Our data suggest that FM-only imaging could be performed in patients with suspected gallbladder disease without loss of accuracy.
Cholelithiasis↗
Charcoal bezoar. Small-bowel obstruction secondary to amitriptyline overdose therapy.
Nasogastric administration of activated charcoal is effective in decreasing the half-life of amitriptyline. A case is reported in which this therapy for amitriptyline overdose led to charcoal bezoar formation and small-bowel obstruction. Amitriptyline's atropinic side effects on the gut make this a possible complication in such patients.
Adult↗
Giant fibroadipose polyp of the esophagus.
A patient with giant fibroadipose polyp of the esophagus is reported. A new observation, a corrugated appearance localized to the segment of the esophagus containing the intraluminal tumor, is discussed. In addition, the computed tomography appearance of the tumor is presented.
Adult↗
Hepatic epithelioid hemangioendothelioma.
Epithelioid hemangioendothelioma (EHE) is a rare, malignant neoplasm of vascular origin arising in soft tissues, lung, and liver. Four cases of hepatic EHE are reported, and 49 previously reported cases are reviewed. The tumor occurs in adults of all ages; 66% of patients are women. The prognosis is variable. Computed tomographic findings suggest the tumor begins as multiple hepatic nodules that grow and coalesce, forming large confluent masses preferentially involving the liver periphery. Extensive hepatic involvement is associated with enlargement of uninvolved portions of the liver and splenomegaly. Awareness of the radiologic features is helpful because clinical findings are nonspecific, and biopsy specimens may be misinterpreted as carcinoma or venoocclusive disease.
Adult↗
Color-flow Doppler sonography in Graves disease: "thyroid inferno".
Graves disease is a common diffuse abnormality of the thyroid gland usually characterized by thyrotoxicosis. We performed color-flow Doppler sonography in 16 patients with Graves disease and compared the results with those in 15 normal volunteers and 14 patients with other thyroid diseases (eight with multinodular goiter, four with focal masses, and two with papillary thyroid carcinoma). All 16 Graves disease patients exhibited a pulsatile pattern we call "thyroid inferno." This pattern consists of multiple small areas of intrathyroidal flow seen diffusely throughout the gland in both systole and diastole. In systole, both high-velocity flow (color coded white) and lower velocity flow (color coded red and blue) were noted. In diastole, fewer areas of flow and lower velocity flow were noted. Patients with Graves disease also exhibited color flow around the periphery of the gland. The inferno pattern did not occur in normal subjects or in patients with other thyroid diseases. On occasion, focal areas of intrathyroidal flow were detected in patients with multinodular goiter and focal thyroid masses. High-resolution gray-scale images did not show the small vascular channels from which the flow signal originated. Color-flow Doppler sonography shows promise as a cost-effective, noninvasive technique for diagnosing Graves disease.
Blood Flow Velocity↗
CT of amebic liver abscess.
CT findings in 23 patients with amebic liver abscess were analyzed retrospectively. A solitary abscess was present in 17 patients. Five patients had two to five lesions. One patient, a male homosexual, had 15 abscesses. Of the 46 abscesses, 74% occurred in the right lobe. The lesions were generally round or oval. One-half of the abscesses were 2-6 cm in diameter; 11% measured 13-16 cm. An enhancing wall was present in most cases. An incomplete rim of edema was seen in eight abscesses. The margin of the abscess was smooth in 63% and nodular in 37%. Internal septations were noted in 30%. Four patients had focal intrahepatic biliary dilatation peripheral to an abscess. One patient had intraabscess hemorrhage. Extrahepatic abnormalities were present in 18 patients; right pleural effusion (nine), perihepatic fluid collection (five), gastric or colonic involvement (eight), and retroperitoneal extension (one). Gas within an abscess was due to hepatobronchial fistula in one patient and hepatocolic fistula in another. Amebic abscess should be included in the differential diagnosis when CT shows one or more cystic or complex masses in the liver, especially when there is evidence of extrahepatic extension.
Adolescent↗
Tumor thrombosis of the inferior vena cava due to retroperitoneal germ cell tumor.
Three patients (2 males and 1 female), aged 17-28 years, with tumor thrombosis of the inferior vena cava due to retroperitoneal germ cell tumor are reported. Diagnostic and therapeutic implications of this condition are discussed.
Adolescent↗
Cavitating metastases of the stomach and duodenum.
Three patients with cavitating gastric or duodenal metastases are presented. Metastatic disease, either by direct extension or by hematogenous spread, should be included in the differential diagnosis of an excavated exoenteric gastric or duodenal mass.
Adenocarcinoma↗
Merkel cell carcinoma.
Merkel cell carcinoma is a rare malignant neoplasm of the skin which is locally invasive and frequently metastasizes to lymph nodes, liver, lungs, bone, and brain. Computed tomographic and pathologic findings in an elderly woman with Merkel cell carcinoma of the buttock and regional nodal metastasis are reported. The presence of calcitonin and neuron-specific enolase within the tumor supports the theory that Merkel cell carcinoma is a neuroendocrine tumor derived from the APUD (amine precursor uptake and decarboxylase) system.
Aged↗
Coexistent xanthogranulomatous pyelonephritis and renal cell carcinoma.
A patient who presented with coexistent xanthogranulomatous pyelonephritis and renal cell carcinoma is reported. Nine previously reported cases are reviewed and the possible significance of this association is discussed.
Aged↗