Case of the month #49: is this "ovarian vein syndrome"?
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Biomedical subjects
Publications and source records attributed to G D Pond.
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It is possible to image a variety of anomalies and pathologic conditions of the vascular system by means of computed tomography (CT). Noninvasive preoperative evaluation of aneurysms frequently can best be accomplished by CT, often providing more usable information than angiograms or even ultrasound. The use of a "bolus" of contrast, with scans performed immediately following the injection, after an initial nonenhanced study, provides excellent definition of such lesions. In this report we relate our experience with CT in patients with aneurysms.
A patient with cholestatic jaundice, ascending cholangitis and recent development of sepsis had an unsuspected intrahepatic abscess discovered by "skinny needle" percutaneous transhepatic cholangiography (PTC). Ultrasound and computed tomography (CT) evaluation were omitted in the work-up because of the clinical impression that the disease was almost certainly due to an obstructing calculus. The unsuspected cause of cholestasis was found by PTC but would have more easily been detected by other means, as a second similar case illustrates.
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A case of massive rectal hemorrhage from a previously unreported source is presented. Localization of the bleeding site was made angiographically after failure of proctoscopy to demonstrate the lesion. Careful evaluation of the rectal region in patients with massive hemorrhage is indicated.
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A case of adrenal hemorrhage of the newborn, diagnosed by ultrasound, is presented. All other diagnostic modalities were found to be non-specific. Ultrasonic evaluation is recommended in the evaluation of pediatric abdominal masses. This is a safe, non-invasive, rapid and easily performed study. It is felt that the use of diagnostic ultrasound in evaluating neonates for adrenal hemorrhage wil obviate the necessity of more invasive procedures, such as exploratory laparotomy.
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To better understand the use of magnetic resonance angiography (MRA) in evaluating peripheral vascular disease, the authors studied arteries in the foot and ankle. Twenty patients with arterial occlusive disease of the lower extremity were studied with two-dimensional time-of-flight MRA, and the results were compared with those of 10 conventional x-ray arteriograms, four digital subtraction arteriograms, and three intraoperative arteriograms. The studies were reviewed and rated by three radiologists blinded to the patients' clinical history. Also, the first 16 patients were examined with MRA before and after intravenous injection of gadopentetate dimeglumine. The mean confidence levels for the reviewers' interpretations of the MRA studies were significantly higher than those for the conventional arteriograms for the medial plantar, lateral plantar, and plantar arch arteries of the feet (P < or = .005). Postcontrast MRA images were inferior to precontrast images because of overlapping of veins and arteries. Time-of-flight MRA without gadolinium can serve as a useful complementary study for evaluating patients with peripheral vascular disease in the foot and ankle.
A body tissue will vary in its CT value from one study to another not only because of changes in its physiology, but also because of technical factors related to the scanning procedure itself. Changing the mAs of a scan and/or position of a substance within the CT scanner was shown by the use of a phantom study to give a small relative but readily measurable change in the CT value of the substance. Thus, small relative changes in CT numbers should be regarded with caution when comparing one substance or area with another or one study with another.
Two cases of neonatal neck masses are presented where computed tomography was valuable in the diagnosis, as well as determining the extent of involvement.