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Biomedical subjects

E K Fishman

Publications and source records attributed to E K Fishman.

At least 523 records · Page 29Linked to original sources
PubMedDate not supplied

Spiral CT with 3D reconstruction in children requiring reoperation for failure of chest wall growth after pectus excavatum surgery. Preliminary observations.

Pectus excavatum is the most common congenital chest wall deformity. Extensive corrective surgery prior to age 3 may disturb chest wall growth and result in a constricted thorax. We describe our surgical and radiologic experience with eight such cases, paying particular attention to the role of spiral computed tomography (CT) with 3D reconstruction in patient management. Spiral CT was performed on children who had developed restrictive chest walls following pectus excavatum surgery. These children then underwent a unique operation to elevate the sternum and attempt to correct their restrictive chest wall defects. In several cases, postoperative spiral CT was performed. Spiral CT with 3D reconstruction defined the orientation of the ribs and costal cartilages and their relationship to the sternum, allowing exact preoperative measurement of the bony rib cage and guiding individualized operative correction. Computed thoracic volumes in select cases correlated well with subjective patient reports of increased exercise capacity. Repair of pectus excavatum defects prior to age 3 may result in constrictive thoracic abnormalities. Surgical correction can increase thoracic volume and improve prospects for normal thoracic function. Three-dimensional reconstruction of spiral CT data is useful in both preoperative and postoperative evaluation.

Adolescent↗
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Breast carcinoma metastatic to the esophagus. CT findings with pathologic correlation.

The common sites of metastasis from breast carcinoma include local and distant lymph nodes, lung parenchyma, bone, liver and brain. While less common, gastrointestinal carcinoma, involving everything from the tip of the tongue to the rectum, secondary to metastatic breast carcinoma have been reported. Many of these lesions occur years after treatment of the primary breast cancer and they can be confused with a second primary. We present a case of breast cancer metastatic to the esophagus which produced symptoms of progressive dysphagia in a women thirteen years after mastectomy and radiation therapy for breast cancer.

Aged↗
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Cystic fibrosis: spectrum of thoracic and abdominal CT findings in the adult patient.

Cystic fibrosis (CF) is an autosomal recessive disorder that is characterized by an abnormality of exocrine gland function. Adult patients represent a rapidly growing percentage of the CF population. Pulmonary changes are seen in nearly every case and are the most serious complication of CF. In advanced lung disease, bronchiectasis, emphysematous bullae, and subpleural blebs can frequently develop. Although pulmonary disease is the most common cause of death and morbidity among CF patients, there also can be involvement of other groups, particularly in adults, which show characteristic signs on CT and spiral CT. Pancreatic abnormalities are present in 85-90% of CF patients. The degree of pancreatic involvement varies, ranging form accumulations of mucus in the small ducts to totally plugged ducts, which can cause atrophy of the exocrine glands and progressive fibrosis. Pancreatic dysfunction on CT is demonstrated as fatty replacement and fibrosis of the pancreas. However, there may be scattered foci of pancreatic calcifications that can be detectable on plain radiographs. Hepatobiliary involvement follows the same pattern as pancreatic abnormalities. Bile canaliculi are plugged by mucinous material and when this plugging is of long duration, biliary cirrhosis with diffuse hepatic nodularity may develop. Such severe hepatic involvement is see in only about 2-5% of patients, although minor hepatic alterations, such as diffuse fatty changes, are fairly common. Hepatobiliary involvement is characterized by hepatic nodularity, compatible with cirrhosis, splenomegaly, and ascites. Complete obstruction of the ileum by meconium occurs in approximately 10% of newborns with CF. Intestinal findings on CT include obstruction, although this is more common in children. These CT signs should be evaluated carefully in adult patients since they may be suggestive of CF. Computed tomography offers unique information about organ involvement (other than pulmonary) that can alter diagnosis and patient management.

Adult↗
PubMedDate not supplied

Atypical extralobar sequestration: CT-pathological correlation.

Pulmonary sequestration is a malformation comprised of dysplastic lung tissue without normal communication with the tracheobronchial tree and with an anomalous systemic arterial supply. Pulmonary sequestration is classified into two types, intralobar and extralobar based on the location of the malformation and the venous drainage. Extralobar sequestration is less common than intralobar sequestration and usually has systemic venous drainage into the azygos system. Most patients with extralobar sequestration are diagnosed before the age of 10. We present an interesting and unusual case of extralobar sequestration which presented as a retroperitoneal mass in an asymptomatic adult.

Adult↗
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Identification of the aberrant hepatic artery with axial spiral CT.

PURPOSE: To determine whether axial spiral computed tomography (CT) allows detection of the replaced hepatic artery as part of preoperative planning for pancreatic tumor resection. MATERIALS AND METHODS: Axial spiral CT scans (8-mm section thickness, 4-mm overlapping reconstructions) were obtained in 50 patients with periampullary tumor and were examined by three radiologists. Readers' interpretations were compared with angiographic results. RESULTS: Eight patients had an aberrant hepatic artery. Two of the three readers detected or suspected all of these abnormalities (100% sensitivity), and one reader identified seven of eight aberrant arteries (88% sensitivity). However, readers requested angiographic confirmation in 14 of 24 tests. Sensitivity, specificity, and accuracy were 96%, 87%, and 88%, respectively, for all readers. CONCLUSION: Axial spiral CT may simplify preoperative evaluation of periampullary tumors. However, angiographic support was necessary in most cases in this study. Improvements in CT techniques may eventually allow spiral CT to replace angiography in the examination of these patients.

Ampulla of Vater↗
PubMedDate not supplied

Computed tomography of abdominal carcinoid tumor.

Computed tomography of the abdomen was performed in 10 patients with pathologically proven carcinoid tumor. In four patients numerous tiny punctate and radiating densities were seen in the mesentery. Two of these patients also had rounded mesenteric masses, 2.5-5 cm in diameter. The presence of punctate or radiating mesenteric densities reflecting desmoplastic reaction, when combined with rounded mesenteric masses or liver metastases, is highly suggestive of carcinoid tumor. The CT appearance of the hepatic metastases in this group of patients was also assessed and found to be nonspecific.

Aged↗
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Gastric leiomyosarcoma: CT observations.

The abdominal CT examinations of seven patients with gastric leiomyosarcoma (GLMS), proven by surgical or endoscopic biopsy or both in five patients and percutaneous aspiration biopsy in two, are reviewed. In the six patients studied prior to therapy, CT demonstrated that each of the primary gastric tumors was spherical or ellipsoidal, large (mean diameter 15 cm), and predominantly exogastric in location. Additional CT features of the primary tumor included necrosis in all six masses, a distinct gastric mural attachment in four, bubbles of gas or an air-fluid level or both in three, and mucosal ulceration in two. Direct tumor invasion of nearby organs was suggested by CT in four of the six patients, the spleen and pancreas representing the most frequent sites. Intraperitoneal spread of tumor was present in two patients; necrotic liver metastases accompanied three of the six primary tumors and were found in an additional patient examined 4 years after gastric resection. By accurately reflecting the biological behavior of GLMS, CT is an ideal imaging modality for studying this unusual neoplasm. Differential diagnosis and specificity of the CT findings are discussed.

Adult↗
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Torsion of lipoma of appendix epiploica: CT evaluation.

We present a case of a large abdominal mass of fat density on CT, which proved at surgery to be a lipoma arising in an appendix epiploica. The clinical, pathological, and radiological aspects of appendices epiploicae are discussed.

Aged↗
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External jugular vein thrombosis: CT demonstration.

A case of external jugular venous thrombosis secondary to misplacement of central venous catheter is presented. The CT findings included enlargement of the external jugular vein, central thrombosis, and vessel wall enhancement. Computed tomography is an excellent noninvasive modality for the evaluation of suspected venous thrombosis.

Adult↗
PubMedDate not supplied

Computed tomography in radiation therapy treatment planning of hepatic metastases.

Forty-four patients with symptomatic hepatic metastases from a colon primary had CT prior to radiation therapy treatment planning. A control group of 44 patients with no evidence of liver metastases was analyzed for comparison. The objectives of planning were to deliver as homogeneous a dose to the whole liver as possible and no treat one kidney or more than one-half of both kidneys. Conventional anteroposterior/posteroanterior portals were found to be inadequate for the treatment of 60% of patients with metastases and 10% of patients with no liver involvement. Among the metastatic group, 50% required oblique planning, 40% anteroposterior/posteroanterior and 9% posteroanterior and left lateral portals to meet the treatment planning objectives. Among the control group of patients with no liver metastases, only 9% required oblique portals and 8% could not be treated because of left hydronephrosis or a solitary right kidney. It is concluded that all patients receiving radiation therapy to the liver for symptoms or prophylaxis require CT for optimum radiation therapy treatment planning.

Colonic Neoplasms↗
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Computed tomography of renal tuberculosis and its pathological correlates.

Computed tomographic studies of eight patients with proven renal tuberculosis demonstrated a spectrum of findings related to the extent and the severity of kidney involvement. In early or focal disease, obstruction of a single major calyx or a group of minor calyces was noted (four cases) with no excretion of contrast material into the affected calyces (three cases) and cortical thinning. Tuberculosis of the renal pelvis (five cases) was manifested by either pelvic dilatation secondary to ureteropelvic junction obstruction (three patients) or diffuse pelvic contraction (two patients). In far advanced disease (four cases) the kidneys were small and exhibited atrophy with replacement of parenchyma by one or more low density areas. Calcifications (37.5%) were identified in the parenchyma and within the calyces. Computed tomography may provide the first clue in suggesting the inflammatory nature of a renal mass and excluding a neoplastic process. Computed tomography is also of value in determining the full extent of extrarenal involvement and the amount of residual functioning parenchyma, both of which are critical in proper treatment planning.

Adult↗
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Computed tomography of stress fractures.

Three cases of stress fractures of the lower extremities are presented with corresponding CT. Findings of increased medullary cavity density, endosteal sclerosis, callus formation, and soft tissue swelling are demonstrated even though they are thought to be nonspecific in differentiating stress fracture from infectious or neoplastic processes. Only when actual failure lines are demonstrated by CT can stress-related injury be specifically suggested.

Child↗
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CT volumetrics of primary liver cancers.

A new computer algorithm is described for liver and tumor volume determinations for patients with hepatoma and primary hepatic cholangiocarcinoma. The algorithm is based on global histograms of CT numbers of the liver and primary liver cancers. The algorithm includes computer-assisted definition of the liver boundary in each CT slice. Liver and tumor volumes of 10 patients calculated by the histogram method were compared with volumes obtained from CT slices that were manually contoured by experienced observers. A correlation coefficient of 0.995 was determined for these two methods of volume computations. Mean values of the differences in volumes obtained by the two methods were 6.7 and 8.0% for the liver and tumor, respectively. The computer algorithm was tested on CT scans for an additional 46 patients by highlighting regions corresponding to normal liver and tumor tissues in each CT slice and determined to be accurate by experienced observers. The computer software is being used clinically to assess tumor response in a new treatment program for primary liver cancers that includes radiolabeled antibodies.

Adenoma, Bile Duct↗
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Computed tomography of high density renal cysts in adult polycystic kidney disease.

In a review of abdominal CT in patients with adult polycystic kidney disease 24 patients were found to have single or multiple high density renal cysts on nonenhanced studies. All cases showed well defined, homogeneous high density cysts (56-98 HU), with smooth contours, sharp interfaces with renal parenchyma, and lack of contrast enhancement. The benign nature of these lesions was established by tissue examination in five patients and follow-up CT in four others. In the remaining 15 patients the benign nature of these lesions was assumed based on the constellation of CT and clinical findings.

Acute Kidney Injury↗