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Biomedical subjects

E K Fishman

Publications and source records attributed to E K Fishman.

At least 505 records · Page 28Linked to original sources
PubMedDate not supplied

Complications of interventional radiology: an imaging overview.

The growth of interventional radiology has contributed to the development of more complex procedures applicable to an increasing patient population, with maintenance of low complication rates. However, due to its invasive nature, potential complications will always be associated with each procedure. Prompt recognition of these complications allows for rapid treatment with decreased patient morbidity and mortality. This overview provides detailed statistics and diagnostic imaging for evaluation of a wide spectrum of complications from hepatobiliary, renal, and vascular interventional procedures.

Angiography↗
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Primary ovarian tumors in the pediatric patient: CT evaluation.

Primary ovarian tumors in the pediatric age group are rare with limited descriptions on computed tomography (CT). We describe the CT findings in a series of nine mature cystic teratomas, one immature teratoma, two granulosa cell tumors, and one undifferentiated small cell tumor. Four mature cystic teratomas were atypical in their CT appearance. The immature teratoma was distinguished by its large, irregular, diffusely calcified solid component. The malignant tumors were large and nearly totally solid, or if multicystic, contained a large solid component.

Adolescent↗
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Intrahepatic, extramedullary hematopoiesis mimicking hemangioma on technetium-99m red blood cell SPECT examination.

Cavernous hemangiomas are the most common lesion of the liver. Because of the risk of hemorrhage inherent in percutaneous biopsy of such lesions, noninterventional modalities (such as CT, ultrasound, MRI and Technetium-99m red blood cell imaging) have been utilized for differentiating them from other lesions. The sensitivities and specificities of these techniques vary greatly. Technetium-99m red blood cell imaging with planar and SPECT imaging has been shown to have an overall sensitivity of 89%, a specificity of 100%, and an overall accuracy of 92%. Despite its high accuracy, rare false positives have been reported with Technetium-99m red blood cell imaging with SPECT. Review of the literature indicates four cases of hepatocellular carcinoma, one case of hepatic angiosarcoma, and one case of hepatic metastases from colorectal carcinoma as having an appearance identical to hemangioma with this modality. We present an additional false positive of a focal region of intrahepatic extramedullary hematopoiesis in a patient with Gaucher's disease as having an appearance on Technetium-99m red blood cell imaging with SPECT identical to that of hemangioma.

Animals↗
PubMedDate not supplied

Multiplanar display of spiral CT data of the pulmonary hila in patients with lung cancer. Preliminary observations.

Spiral or helical computed tomography (CT)-generated multiplanar reconstructions were used in the radiological assessment of the pulmonary hila in patients with central lung cancer. Twelve patients with non-small-cell lung cancer and hilar abnormalities were examined with contrast-enhanced spiral CT. Studies were performed on a Siemens Somatom S or Plus-S scanner using either a 24- or 32-second spiral. The study volume was from the arch of the aorta to the inferior pulmonary veins done in a single breath-hold, using 4-mm collimation, and reconstructed at 2-mm intervals. We assessed the quality of vascular enhancement and of multiplanar reconstructions. Bronchoscopic, surgical, and pathological findings were correlated. Excellent vascular opacification and good-quality reconstructions were obtained in all patients. No interscan motion was detected. No problems were encountered with the breathholding technique or in the reconstruction of images, even in patients with poor respiratory function. Multiplanar reconstructions were useful for the evaluation of mediastinal including vascular and airways invasion, for optimal definition of lymph node groups, for the planning of bronchoscopically guided biopsy, as well as for endobronchoscopic laser coagulation therapy and surgical treatment. Spiral CT-generated multiplanar reconstructions of the hila are helpful for staging, solving problems, guiding bronchoscopy, and planning surgery. Even patients with limited respiratory reserve can successfully complete the examination.

Aged↗
PubMedDate not supplied

Spiral CT. Initial experience with vascular applications.

Spiral computed tomography (CT) scanning is the latest technical advance in rapid scan techniques. In spiral CT, the patient is advanced at a constant rate through a continuously rotating CT gantry. The resulting CT data represent a true volume acquisition. Because of rapid scan acquisition, optimum vascular enhancement by intravenous or intraarterial contrast can be readily achieved. In addition, high quality multiplanar and three-dimensional reconstructions can be obtained because of lack of respiratory motion. Applications of spiral CT for vascular studies include evaluation of thoracic or abdominal aneurysms, vascular occlusion from thrombus or tumor, and vascular malformations. In this article, we present vascular applications of spiral CT through a series of illustrative cases.

Aged↗
PubMedDate not supplied

CT of primary colonic lymphoma.

The article presents the computed tomography (CT) findings in 15 patients with histopathologically proven primary lymphoma of the colorectum. CT is invaluable for the characterization of primary colonic lymphomas and for definition of tumor invasion and spread. The lymphomas in our series were categorized according to their CT appearance as either discrete bulky masses (n = 6), focal mural infiltration (n = 5), or diffuse colonic invasion (n = 5). Primary colonic lymphomas that were manifested as mass lesions had a greater depth of mural invasion (x = 4.3 cm) than did infiltrative lesions (x = 2.7 cm, P < .05), and tended to present at an earlier stage. In the setting of solitary mass lesions in the colon that are not associated with adenopathy, CT findings can help to distinguish primary lymphoma from adenocarcinoma. Cecal tumors that grow into the terminal ileum, tumors which are fairly well demarcated from the surrounding pericolonic fat and show no evidence of invasion or obstruction of neighboring viscera, and tumors which perforate in the absence of desmoplastic reaction should suggest lymphoma. A clinical history of human immunodeficiency virus infection should also prompt consideration of colonic lymphoma.

Adenocarcinoma↗
PubMedDate not supplied

Primary amyloidosis of the sternum. Imaging findings.

A rare case of focal primary amyloidosis is presented with CT and MR correlation. Imaging findings demonstrate an expansile, mixed sclerotic and lytic lesion in the sternum, with MR signal characteristics similar to those previously described for diffuse primary amyloidosis and hemodialysis-related amyloidosis.

Adult↗
PubMedDate not supplied

CT appearance of acute abdomen as initial presentation in lymphoma of the large and small bowel.

Computed tomography (CT) is playing an increasingly greater role as the initial diagnostic imaging modality for acute abdomen. Abdominal pain is the most common presenting complaint for intestinal lymphoma, and acute abdomen is a not infrequent admitting complaint. We present the CT findings of five patients with intestinal lymphoma whose initial complaint was acute abdomen. Of these five patients, four had an identifiable mass that was located in the right lower quadrant, with the fifth patient having no identifiable mass on CT. The average mass size was 7.8 cm. Three of the patients showed involvement of the colon only, and two showed involvement of the small bowel only, with acute abdomen in only one of the patients with small-bowel involvement being due to direct extension from mesenteric lymph nodes. Pneumoperitoneum and free intraperitoneal fluid were seen in two patients. It is important, therefore, that the radiologist be aware that one of the causes of acute abdomen with primary bowel involvement is lymphoma, which can simulate appendicitis or diverticulitis in its presentation clinically and by physical examination.

Abdomen, Acute↗
PubMedDate not supplied

Inflammatory pseudotumor of the terminal ileum mimicking malignancy in a patient with Behçet's disease. CT and pathological findings.

Behçet's disease is an idiopathic, recurrent multisystem syndrome characterized by oral aphthous ulcers, genital ulcers, and ocular inflammation. Small bowel involvement may occur in 1% of patients with aphthous ulceration which may mimic Crohn's disease. We report a case of a patient with Behçet's disease with small bowel pathology which simulated a mass and at surgery was an inflammatory pseudotumor. Inflammatory pseudotumors can be mistaken for a malignancy as was the case in this patient.

Adult↗
PubMedDate not supplied

Pancreatic metastases from renal cell carcinoma in von Hippel-Lindau disease.

von Hippel-Lindau (VHL) disease is an unusual inherited chromosomal dominant disease characterized by CNS hemangioblastomas and visceral neoplasms. Multiple abnormalities may involve the abdomen including pathology in the liver, pancreas, kidneys, and adrenal glands. The present case report describes a patient with renal cell carcinoma in von Hippel-Lindau disease. What was most unusual about this case was that the patient also developed pancreatic masses that were metastatic disease from renal cell carcinoma.

Adult↗
PubMedDate not supplied

Biliary tract obstruction. The role of spiral CT in detection and definition of disease.

The purpose of this study was to assess the efficacy of spiral computed tomography (CT) in determining the etiology of biliary tract obstruction. Spiral CT studies performed over a 9-month period in 42 consecutive patients with suspected biliary tract obstruction were reviewed. Analysis of scans included localizing the obstruction and then defining a specific etiology. Pertinent associated findings such as porta hepatis or peripancreatic adenopathy, hepatic or peritoneal metastases, and pancreatic pseudocyst or abscess formation were also assessed. Spiral CT demonstrated the level of obstruction in all 30 patients in whom there was biliary tract dilatation. Thirty-two diagnoses were rendered in 30 patients, with specific obstructing lesions identified in 28 instances (88%). Twenty-five (78%) of 32 specific pathological diagnoses were correct. The positive predictive value for neoplasms in the pancreatic head was 100% (n = 17). Two patients with characteristic CT changes of sclerosing cholangitis were diagnosed as having superimposed cholangiocarcinoma, although the results of biopsies for neoplasm were negative. The sensitivity of spiral CT for detection of common duct calculi was 67% (n = 3). Due to optimal contrast enhancement of both hepatic and pancreatic parenchyma, spiral CT enables excellent visualization of the biliary system and provides a specific explanation for biliary tract obstruction in nearly all cases. Spiral CT can usually distinguish neoplastic from nonneoplastic causes of jaundice. When distal common duct obstruction is detected in the absence of an identifiable mass or focal ductal wall thickening, neoplasia is unlikely. It is difficult to exclude sclerosing cholangitis from cholangiocarcinoma on the basis of spiral CT findings, and in these patients, biopsy or close follow-up is recommended to exclude the possibility of a biliary neoplasm.

Adult↗
PubMedDate not supplied

Nontraumatic focal lesions of the spleen: assessment of imaging and clinical evaluation.

Fifty-nine cases of nontraumatic splenic disease were reviewed to evaluate the roles of clinical findings, computed tomography, ultrasound, and radionuclide scanning in diagnosis and management. Patient groups included lymphoma (30 patients), infarct (11 patients), abscess (9 patients), cyst (5 patients), hemangioma (3 patients), and hamartoma (1 patient). In no case were clinical findings alone sufficient to diagnose a splenic lesion. Clinical and laboratory manifestations were nonspecific in all groups. Moreover, no radiologic study reliably diagnosed splenic lymphoma or leukemia. All other focal splenic lesions were consistently diagnosed noninvasively. Cross-sectional imaging was more useful than radioisotope scanning, and often provided adjunctive diagnosis of extrasplenic pathology. The superior detail, spatial resolution, and sensitivity of computed tomography made it the single most valuable diagnostic modality.

Abscess↗
PubMedDate not supplied

Perforation of the small bowel as a complication of laparoscopic cholecystectomy: CT findings.

Despite the widespread use of laparoscopic cholecystectomy, technical complications unique to the laparoscopic approach may lead to significant postoperative morbidity and mortality. We report a rare case of small bowel perforation due to trocar injury that led to extensive pneumoperitoneum and pneumomediastinum in a patient who underwent laparoscopic cholecystectomy. Small bowel injuries should be suspected when a large or an increasing amount of free air is detected following this procedure.

Adult↗
PubMedDate not supplied

Spiral CT: clinical applications in the gastrointestinal tract.

Spiral CT provides the ability to acquire single breathhold volume acquisitions that allow for optimization of the infusion of iodinated contrast material and CT data acquisition. Although initial applications focused on the chest, liver, and vascular system, spiral CT has important implications for the tubular structures of the GI tract (esophagus, stomach, small bowel, and colon). Tumor detection and staging may be optimized by these better datasets which also provide multiplanar and 3D imaging capabilities. This article reviews many of these specific applications and emphasizes the potential value of spiral CT scanning.

Aged↗