Three-dimensional imaging of an Egyptian mummy.
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Humans↗
Biomedical subjects
E K Fishman
Publications and source records attributed to E K Fishman.
Real-time, multiplanar computerized tomography: a new diagnostic modality used in the detection and endoscopic removal of a distal ureteral fibroepithelial polyp and adjacent calculus.
Ureteral fibroepithelial polyps are rare benign mesodermal tumors that occur predominantly in the upper ureter. We report on a patient with a fibroepithelial polyp in the distal ureter that resulted in entrapment of a calculus and partial obstruction of the collecting system. Preoperatively, diagnosis by standard radiographic methods, such as excretory urogram, retrograde pyelogram and conventional computerized tomography with and without contrast enhancement, was not possible because of the close proximity of the fibroepithelial polyp, the ureteral calculus and calcifications in the adjacent internal iliac artery. The new diagnostic modality of real-time, multiplanar computerized tomography imaging using the Sun/Pixar computer system and the 2D/3D Orthotool software was used to make the correct preoperative assessment. Subsequently, the patient underwent ureteroscopic resection of the polyp and extraction of the calculus. A year later she was free of symptoms and there was no evidence of regrowth of the polyp. To our knowledge this is the first report to describe the use of real-time, multiplanar computerized tomography imaging as an effective diagnostic modality in the genitourinary tract. In addition, this is the first ureteral fibroepithelial polyp reported in the literature to be associated with a ureteral calculus and to be excised endoscopically with no recurrence on long-term followup.
Endoscopy↗
Enhanced computed tomographic techniques for the evaluation of total hip arthroplasty.
Computed tomography (CT) has revolutionized the evaluation of musculoskeletal pathology. Until recently, however, CT of the postoperative orthopaedic patient has been severely limited by its inability to provide useful information in the vicinity of acetabular and femoral implants. Typically the hardware produces extensive artifacts that can markedly degrade the whole image. Methods are now available to reduce the metal artifact. Following hip arthroplasty, these methods have been used to plan for revision arthroplasty and to evaluate the contralateral side for avascular necrosis.
Evaluation Studies as Topic↗
Nonunion of acetabular fractures: evaluation with interactive multiplanar CT.
Nonunions involving fractures of the acetabulum are reportedly rare, with few citings and little discussion in the literature. It is possible that acetabular nonunions go undetected because imaging of the acetabulum is difficult by conventional radiography. We report two cases of fracture nonunion involving the weight-bearing surface of the acetabulum diagnosed with the aid of computed tomography (CT) and a newly developed interactive 2D/3D orthotool (copyright and trademark of the Body CT Imaging Laboratory, Department of Radiology, The Johns Hopkins Medical Institutions) that uniquely processes and reformats routine CT data. The interactive 2D/3D orthotool is a sophisticated computer program that allows dynamic viewing of standard multiplanar reconstructions in the axial, coronal, and sagittal planes as well as multiple oblique projections. The 2D/3D orthotool provides on screen correlation of two-dimensional multiplanar images with three-dimensional reconstructions of the pelvis. The authors found this capability ideally suited for studying fractures with off-axis orientation such as those through the acetabular dome, greatly facilitating the diagnosis of nonunion.
Acetabulum↗
Advanced three-dimensional evaluation of acetabular trauma: volumetric image processing.
Volumetric image processing is a new approach to generating simulated three-dimensional images from transaxial CT data. The major advantages compared to conventional surface-rendering 3D technique include: preservation of every pixel of CT data for increased accuracy of rendered image; tissue layer translucency allowing appreciation of multiple tissue layers on each image; simulation of real-time rotation in varying axes for optimal appreciation of abnormalities; and a high-speed, high-capacity computer setup which generates high-quality images rapidly, giving the system sufficient flexibility for these complicated functions while remaining user friendly and fast.
Accidents, Traffic↗
Bronchioalveolar carcinoma: emphasis on localized lesions.
Although well defined pathologically, alveolar cell carcinoma can be difficult to diagnose because of its many clinical presentations. In a retrospective study of 45 cases, we reviewed the radiologic, pathologic, and clinical features of this neoplasm. Forty-one patients had a single peripheral mass that measured between 8 mm and 7 cm. Three patients had multiple nodules, and one had diffuse involvement of the right lung. Other prominent radiologic features included air bronchograms in eight cases, a "tail sign" in ten cases, and universal absence of calcifications. Pathologic examination showed an associated scar in 12 patients. There was a relatively high frequency (16%) of metachronous malignancies, including two osteosarcomas, three basal cell carcinomas, and one case each of chronic lymphocytic leukemia and thymoma. All but one of the associated tumors were diagnosed six months to two years before the diagnosis of alveolar cell carcinoma.
Adenocarcinoma, Bronchiolo-Alveolar↗
The computed tomographic spectrum of thoracic sarcoidosis.
Thoracic manifestations of sarcoidosis are well recognized on conventional radiographs. Less well known are the CT appearances of sarcoidosis. This article reviews the spectrum of CT findings in sarcoidosis; highlighting distributions of lymphadenopathy on CT, patterns of parenchymal involvement, and pulmonary complications of sarcoidosis as demonstrated by CT.
Humans↗
Diseases of the chest in AIDS: CT diagnosis.
The advantages of computed tomography for the evaluation of various chest lesions commonly encountered in patients with AIDS are discussed. The significance of limited and extensive lymphadenopathy is considered and examples are presented. Also specifically illustrated are cases of opportunistic pneumocystis, cytomegalovirus, and nocardia pneumonitides and of candida esophagitis; septic emboli; empyema; premature bulla formation ranging from apical bullae to diffuse parenchymal destruction; Kaposi's sarcoma, and lymphoma. Examples of the value of CT in resolving obscure clinical chest problems in AIDS patients are also illustrated.
Acquired Immunodeficiency Syndrome↗
Interactive real-time multiplanar CT imaging.
A new software program provides the real-time display of high-resolution computed tomographic reformation in the axial, coronal, sagittal, or oblique views. The advantages of this new technique over the standard multiplanar format include (a) larger image display format, (b) reconstruction of entire dataset for each of up to 192 sections, (c) real-time viewing, (d) interactive real-time oblique imaging, and (e) on-screen correlation of multiplanar and three-dimensional images.
Adult↗
Frequency and determinants of adverse reactions induced by high-osmolality contrast media.
To determine the frequency of and risk factors for adverse reactions to high-osmolality contrast media, the authors prospectively studied hospitalized patients undergoing cardiac catheterization. The authors also studied patients undergoing peripheral angiography and contrast material-enhanced computed tomography (CT) of the head or body who met at least one of the following criteria thought to increase the risk of adverse reactions: age of more than 60 years, diabetes, renal or liver disease, concurrent nephrotoxic drug use, or a history of allergic reactions (n = 795). Criteria were defined and used to group adverse reactions into three classes of clinical severity. Overall, class I (mild), class II (moderate), and class III (severe) reactions occurred in 362 (45%), 44 (5.5%), and three (0.4%) patients, respectively. Class II reactions were relatively common (25%) in patients undergoing cardiac catheterization yet were uncommon (2%) in patients undergoing the other three procedures. Nephrotoxicity occurred in 18 of 651 patients who had follow-up creatinine levels obtained at 48-72 hours. With multivariate regression analysis, the only risk factor (P less than .05) for combined class II and III reactions was diabetes. Diabetes, furosemide use, and a history of atopy (odds ratio = 2.8) were associated with nephrotoxicity (P less than .05). Underlying renal insufficiency was not a risk factor for nephrotoxicity.
Adult↗
Transient intussusception in Crohn disease: CT evaluation.
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Adult↗
Aging of the diaphragm: a CT study.
To determine the normal morphologic evolution of the diaphragm with aging and to correlate age-related changes with other indicators of physical condition--such as skeletal muscle status, obesity, presence of pulmonary emphysema, and presence of esophageal hiatus hernia--a systematic morphometric and morphologic evaluation of computed tomographic studies of 120 patients from the 3d to 8th decades of life was undertaken. Diaphragm muscle thickness did not change significantly with increasing age. Diaphragmatic defects and pseudotumors, nonexistent in the 3d and 4th decades, increased in number and severity to affect 56% of the patients in the 7th and 8th decades. Neither the status of the skeletal muscle nor the presence of obesity correlated with age or with the presence of diaphragmatic defects. Eighty-four percent of the patients with emphysematous changes demonstrated diaphragmatic defects; thus, a strong association with emphysema was observed. If emphysematous patients are excluded, defects were more common in women. The esophageal hiatus width was found to increase with age.
Adult↗
Bacterial renal infection: role of CT.
The imaging studies done on 62 patients hospitalized for acute renal infections were retrospectively reviewed. Thirty-six (58%) had one or more abscesses, 17 (27%) had focal or diffuse acute bacterial nephritis, five (8%) had pyonephrosis, and four (6%) had pyelonephritis. All had prolonged fever (greater than or equal to 72 hours) and leukocytosis. Among 25 patients examined with both ultrasound (US) and computed tomography (CT), US failed to depict three of five (60%) cases of acute bacterial nephritis and seven of 15 (47%) intrarenal and extrarenal abscesses. One renal abscess was misdiagnosed as a tumor at CT. US is not an adequate screening test for detecting lesions that may require invasive therapy. CT is more sensitive for the detection of acute renal inflammatory disease and for defining the extent of disease for planning of radiologic or surgical intervention.
Abscess↗
Premature bullous pulmonary damage in AIDS: CT diagnosis.
The computed tomographic (CT) scans of 55 patients with the acquired immunodeficiency syndrome (AIDS) were reviewed for evidence of pulmonary bullous damage. Although the average age of patients in this series was only 37 years, 42% (23 of 55) had CT evidence of pulmonary bullous changes. In contrast, the frequency of bullous changes detected at CT in a comparable number of immuno-compromised patients with acute leukemia was 16% (eight of 50) (P less than .01). CT findings of bullous damage included bullae or cystic spaces, areas of low attenuation, and vascular disruption. A visual scoring system was used to grade CT scans according to the percentage of lung demonstrating bullous change. Of the 23 AIDS patients with CT evidence of pulmonary bullous damage, 16 (70%) had one or more documented pulmonary infections, while three (13%) had no prior history of lung infection (P less than .05). Spontaneous pneumothorax was a complication of pulmonary bullous damage in three patients. Destruction of pulmonary parenchyma in patients with AIDS may represent the response of the lung to repeated infection.
Acquired Immunodeficiency Syndrome↗
Sequelae of acute renal infections: CT evaluation.
Seventeen patients with upper urinary tract infection who underwent 51 computed tomographic studies (two to five per patient; mean, three) were retrospectively evaluated. Five to 10 days after the initial examination, there was little change in parenchymal abnormalities, but perirenal inflammation worsened and then subsided over 2-8 weeks. Enlargement of the affected kidney, present initially in 12 patients, persisted up to 6 weeks and resolved by 10-16 weeks. Abnormalities of parenchymal contrast material enhancement persisted for 1-2 months. New cortical scars appeared in six of 12 patients with an initially normal renal contour and in one of five patients who had scars initially. Three patients with a renal abscess developed a new calyceal diverticulum, presumably by rupture of the abscess into the collecting system. The present study shows that abnormalities of renal size and enhancement persist for weeks to months after clinical signs of infection resolve and that scarring in adults with urinary tract infection occurs more frequently than was previously realized.
Abscess↗
Fulminant pulmonary calcification complicating renal transplantation: CT demonstration.
The authors report a case of fulminant, metastatic lung calcification leading to progressive respiratory failure in a patient who underwent unsuccessful renal transplantation. Premortem computed tomographic (CT) examination of the lung demonstrated the presence of high-attenuation (greater than 100 HU) parenchymal consolidation, compatible with metastatic calcium deposition. By depicting significant pulmonary calcification not seen on conventional radiographs, CT facilitated identification of an important contributing factor to the patient's respiratory failure and death.
Adult↗
Sonographic observations in a patient with typhlitis.
The sonographic findings in a patient with typhlitis are presented. Sonography showed a solid mass with a "target" sign in the right lower quadrant, continuous with the ascending colon. In addition to suggesting the diagnosis, sonography was helpful in the follow-up examination of the patient because it was able to assess the gradual decrease in the thickness of the bowel wall and ultimate resolution of the inflammatory process.
Anemia, Aplastic↗
Embolotherapy of a high-flow false aneurysm by using an occlusion balloon, thrombin, steel coils, and a detachable balloon.
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Aged↗