Biomedical subjects
Publications and source records attributed to E K Fishman.
Two cases of rupture of the urinary bladder following cystoscopic clot evacuation are presented. Both patients had hemorrhagic cystitis (HC) secondary to cyclophosphamide therapy. The bladder injuries were not immediately recognized. Computed tomography (CT) demonstrated the bladder rupture in both patients.
We describe the findings of an isolated common iliac artery aneurysm that formed a fistulous tract with the terminal ileum diagnosed with dynamic computed tomography (CT). The role of CT in the diagnosis of arterioenteric fistula is addressed.
BACKGROUND: To determine characteristic imaging features of hepatocellular carcinoma (HCC) on spiral CT during arterial portography (SCTAP) and to correlate the presence or absence of spontaneous portosystemic shunts with the degree of hepatic parenchymal enhancement during SCTAP in patients with HCC. METHODS: SCTAP scans of 20 patients with HCC were retrospectively analyzed for tumor features, degree of hepatic parenchymal enhancement, and presence or absence of spontaneous portosystemic shunts. RESULTS: Nineteen tumors (95%) were hypoattenuating masses and one (5%) was isoattenuating compared with the liver on SCTAP. In seven patients (35%), the tumor was homogeneous in attenuation. Tumor margins were smooth and regular in 12 patients (60%). Vascular invasion and encapsulation were depicted in 10 patients (50%). A high degree of hepatic parenchymal enhancement was observed in 14 patients; one of them (7%) had spontaneous portosystemic shunts. Poor or moderate enhancement was observed in six patients; five of them (83%) had spontaneous portosystemic shunts (p < .001). CONCLUSION: The presence of a low attenuated homogeneous intrahepatic mass with associated vascular invasion on SCTAP scans should raise the possibility of HCC. The presence of spontaneous portosystemic shunts is associated with poor or moderate parenchymal enhancement.
We present a case of unsuspected extrahepatic arterial-main portal venous fistula diagnosed by multiphase computed tomography with three-dimensional volume-rendered computed tomographic angiography. To our knowledge, this entity has not been reported previously in the literature, and it represents an example of pathology that may only be detected and clarified with multiphase imaging with three-dimensional rendering. This finding has great clinical importance in patient management.
Computed tomography plays an important role for the evaluation of most patients with suspected renal injury after trauma. Intravenous urography is used for gross assessment of renal function in hemodynamically unstable patients. Renal injuries can be classified into four large groups: (1) minor renal contusion, lacerations, subcapsular hematoma, and small cortical infarcts; (2) major renal lacerations extending to the medulla with or without involvement of the collecting system; (3) catastrophic renal injuries including fragmentation of the kidney and renal pedicle vascular injuries; and (4) ureteropelvic junction injuries. Integration of the imaging findings of renal injury with clinical information is important to developing a treatment plan.
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Successful renal computed tomographic (CT) arteriography requires thin collimation and adequate z-axis coverage. With multidetector CT, 1-mm slices covering the necessary volume are feasible for optimal arterial visualization. In this pictorial essay, we illustrate the usefulness of multidetector CT in evaluating normal arterial anatomy, stenosis, and the renal arteries in aortic disease. The techniques for performing the study and three-dimensional rendering are described.
BACKGROUND: We evaluated the incidence of variations of the middle hepatic vein (MHV) branches and their impact on formal right hepatectomy for living-donor liver transplantation. METHODS: Fifty consecutive patients who underwent hepatic multidetector row computed tomography (CT) were evaluated. Three-dimensional volume rendering techniques were used to evaluate the different branching patterns of the MHV. An incision plane was constructed to simulate a formal hepatectomy along Cantlie's line, immediately to the right of the MHV. The number of transected vessels was recorded by consensus of two observers. RESULTS: In 11 patients (22%) the MHV had no major (>5 mm) branches. In 15 patients (30%) a major branch was seen draining the right lobe, and in 10 patients (20%) a major branch was seen draining each lobe. In five patients (10%) two major branches were seen draining the right lobe and a single branch draining the left lobe. The remaining nine patients (18%) had other variations, including one patient (2%) with the right hepatic vein arising from the MHV. A formal hepatectomy along Cantlie's line was truly avascular in 15 patients (30%). CONCLUSION: A formal right hepatectomy can be performed without transecting major branches of the MHV in one-third of patients. In the remaining two-thirds, one or more major branch of the MHV will need be transected. Preoperative knowledge of these variations is critical for surgical planning.
The diagnosis of recurrent ovarian cancer can be difficult on cross-sectional imaging, and variable sensitivities and specificities have been reported for positron emission tomography (PET). Combined functional and anatomic imaging with PET plus computed tomography (CT) potentially allows for improved detection of tumor masses. We investigated the sensitivity, specificity, and accuracy of PET-CT for the diagnosis of recurrent ovarian cancer. Sixteen women with previously treated ovarian cancer underwent imaging on a combined PET-CT scanner followed by surgery to assess for possible recurrent disease. The fused PET-CT images were retrospectively reviewed for recurrent disease, and the results of PET-CT were compared with the operative notes. Eleven of the 16 patients had recurrent disease at surgery. The sensitivity, specificity, and accuracy of PET-CT for disease detection on a per-patient basis were 72.7%, 40%, and 62.5%, respectively. For cases of malignant adenopathy (n = 7), 100% were detected on PET-CT. For peritoneal lesions no larger than 1 cm (n = 23), 13% were detected on PET-CT. For peritoneal lesions larger than 1 cm (n = 8), 50% were detected on PET-CT. The sensitivity of PET-CT for recurrent ovarian cancer is moderate in patients with low volume disease. A trial involving a larger number of patients with a spectrum of disease volumes is necessary to determine the impact of PET-CT in clinical practice.
Laparoscopic donor nephrectomy has become the accepted method of harvesting the kidney at many institutions because of multiple advantages over open donor nephrectomy. Spiral computed tomographic (CT) angiography provides accurate information of renal vascular anatomy and has become an accepted method of preoperative evaluation of potential laparoscopic renal donors. More recently, multidetector CT (MDCT) provides more detailed datasets compared with single-detector spiral CT and has been used for preoperative evaluation of laparoscopic donor nephrectomy to provide accurate anatomic information. MDCT (especially 16- and 64-slice MDCT) angiography has advantages over single-detector helical CT due to rapid scan time that allows coverage of a large volume of interest with higher spatial and temporal resolutions. In this article, we review the current status of MDCT angiography in the evaluation of laparoscopic renal donors and potential advantages of using this technology.
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BACKGROUND: We investigated whether the left adrenal vein could be consistently localized on three-dimensional (3D) real-time volume-rendering computed tomographic angiographic (CTA) mapping in a group of living renal donors before laparoscopic nephrectomy. METHODS: Sixty-six consecutive potential renal donors were referred for CTA vascular mapping before laparoscopic donor nephrectomy. Thirty-three patients were examined on a single-detector helical CT scanner and the other 33 were examined on a multidetector unit. In each patient, arterial phase and venous phase volumetric data sets were acquired after the intravenous injection of 150 cc of non-ionic contrast material. Three radiologists reviewed the data sets at a free-standing workstation after the application of 3D volume-rendering software and reached a consensus on whether the left adrenal vein was visualized and, when seen, its position relative to the abdominal aorta. RESULTS: The left adrenal vein was found in 92.5% of the 66 donors (91% in the single-detector group and 94% in the multidetector group). The junction of the left adrenal vein and left renal vein averaged 5.2 mm (range = 0-13 mm) from the left lateral wall of the abdominal aorta. CONCLUSION: Three-dimensional real-time volume-rendering CTA with single-detector and multidetector scanners permits consistent localization of the left adrenal vein in more than 90 % of prospective living renal donors.
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BACKGROUND: Little has been written about the use of computed tomography (CT) in the evaluation of small bowel obstruction (SBO) in children. The purpose of this study is to review the CT findings of SBO in a pediatric series and to increase awareness of CT as potential problem-solving tool for SBO in children. METHODS: The medical, surgical, radiographic, and CT scan records of 20 consecutive children with surgically proven SBO were retrospectively reviewed. Duodenal and neonatal obstruction was excluded. CT scans were evaluated for small and large bowel caliber, bowel wall thickening, the appearance of the mesentery, extraluminal abnormalities, and the ability to detect the cause of obstruction. RESULTS: Causes of obstruction included adhesions (nine), small bowel intussusception (four), abscess (two), segmental volvulus (two), Crohn disease (one), focal stricture (one), and internal hernia (one). Small bowel dilatation was present in 19/20 children. Small bowel caliber transition was noted in 17/19 children. Two children with no small bowel caliber transition had a collapsed colon. The colon appeared normal in caliber in nine children, collapsed in nine, and filled with stool proximally and collapsed distally in two. Small bowel thickening was present in six children and mesenteric venous engorgement in three. Specific causes of obstruction were identified on CT in nine children (45%) and could be correctly predicted in seven of nine children with adhesions. In four children, the causes were either not evident or alternate diagnoses could be made. CONCLUSION: CT can be a useful adjunct in evaluating the presence or causes of SBO in children.
PURPOSE: To report our experience with fluid-fluid levels within focal hepatic lesions and determine if this finding indicates a specific diagnosis. MATERIALS AND METHODS: We reviewed our experience with eight patients with focal hepatic lesions that showed fluid-fluid level on cross-sectional imaging. Seven CT scans, four MR examinations, and four sonograms were reviewed. The hepatic lesions included metastases (four patients), biliary cystadenoma (two patients), cavernous hemangioma (one patient), and hematoma (one patient). A histologic diagnosis was made in all cases. RESULTS: Fluid-fluid levels were found in both malignant and benign focal hepatic lesions. Fluid-fluid levels were seen on six CT scans, four MR examinations and on none of the four sonograms. Radiologic-pathologic correlation showed that fluid-fluid levels corresponded to internal hemorrhage in all but one case. In the case of cavernous hemangioma, a fluid-fluid level was found to correspond to a sedimentation effect within a large vascular space. CONCLUSION: Fluid-fluid levels in focal hepatic lesions do not indicate a specific diagnosis but can be seen in both malignant and benign conditions affecting the liver.
The paraumbilical vein is a common venous collateral in patients with cirrhosis and portal hypertension. This pictorial essay demonstrates the use of computed tomographic angiography with three-dimensional volume rendering techniques to visualize the paraumbilical vein and its relationship to abdominal wall collaterals. The unique anatomy and embryology of this vessel is also discussed.
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Serous cystic neoplasm of the pancreas is typically considered to represent a benign pancreatic neoplasm. We present a case where the tumor displayed unusually aggressive behavior with metastatic disease to the liver and pancreatic bed. Although serous cystic neoplasms should be considered a benign lesion and will be cured in most cases by surgical excision, the radiologist should be aware that on occasion they can exhibit aggressive behavior.