Biomedical subjects
Publications and source records attributed to M C Beachley.
A tortuous thoracic aorta is common in the elderly, often displacing the esophagus without causing organic obstruction. The potential for this complication is present, and a case is reported which required surgical relief of this problem.
Thickening of the wall of pulmonary veins in cyanotic congenital heart disease and the presence of hilar vessel anatomic variants may mislead a surgeon into incorrectly anastomosing the subclavian artery to the pulmonary vein when performing a Blalock-Taussig shunt. Emergency selective angiography is the study of choice for the identification of this operative complication.
Massive perineal bleeding due to trauma was successfully controlled by superselective embolization of the internal pudendal artery with a stainless steel mini coil. While in the standard selective procedure the internal iliac artery is embolized, the superselective technique allows preservation of the blood supply from the uninjured branches of the internal iliac artery.
We report eight patients studied by computed tomography (CT) and arteriography and one patient studied by CT only and compare the value of both methods in the preoperative localization of pheochromocytoma. Single adrenal tumors were found in six adults (four were right sided and two were left sided). A 15-year-old child had bilateral adrenal tumors, and a 12-year-old child had a left adrenal tumor. An extraadrenal pheochromocytoma was found in another adult patient. Computed tomography demonstrated all but one tumor (a right adrenal lesion measuring 2.5 cm in the child with bilateral pheochromocytomas, both well shown by angiography). Arteriography, including subtraction films, demonstrated all but one tumor (an avascular extraadrenal pheochromocytoma measuring 4 x 8 cm well shown by CT). We believe that both CT and angiography contribute significant information in the preoperative evaluation of patients suspected of harboring a pheochromocytoma.
Explore the source record for details and available documents.
The clinical and plain radiographic findings of thoracic aortic dissection may not be specific; thoracic aortography is the definitive diagnostic procedure. Ulcerlike projections of contrast material are not commonly found on thoracic aortography, but may be a precursor angiographic sign of dissection. Two patients with ulcerlike outpouchings are presented. In one, the evolution of aortic dissection was documented by three serial aortograms. It began with a small "ulcer" in the ascending aorta that became larger and finally progressed into the typical angiographic appearance. In the other, thoracic aortography demonstrated an ulcerlike projection in the ascending aorta. In both cases, the diagnosis of dissecting hematoma was confirmed by surgery and pathologic examination of the resected specimens. Thoracic aortography in several projections is necessary for demonstration of these ulcerlike outpouchings because they may be evident in only one projection. Conceivably, their recognition may permit earlier diagnosis of aortic dissection and the institution of appropriate treatment.
The authors describe the renal angiographic findings in an 8-year-old child with diffuse infiltration of the kidneys by malignant lymphoma. These findings included irregularity, encasement, occlusion of interlobar branches, and poor opacification of arcuate and interlobular arteries. Although the findings were not entirely specific, the diagnosis can be suggested in the appropriate clinical setting.
The authors report on the preoperative diagnosis of a bleeding jejunal diverticulum by selective arteriography. The angiographic findings, as well as the difficulties of the intraoperative localization of bleeding jejunal diverticula, are discussed.
Angiographic examination in a patient with sciatic-like pain on the right side and a firm, pulsatile, non-tender mass in the right buttock revealed a large sciatic artery aneurysm. The aneurysm was successfully resected at surgery. The primitive sciatic artery is the main arterial supply to the lower extremities in the 9-mm embryo. Its persistence, while very rare, is of clinical significance because of the tendency for aneurysms to develop in the artery. Surgical resection is indicated in sciatic artery aneurysms because of the danger of rupture or embolic occlusion of arteries distal to the aneurysm.
Right-sided retroperitoneal adenopathy or right adrenal masses demonstrated by CT in cross sectional display may mimic the CT appearance of the inferior- vena cava. This finding has been recently described as the "double cava" sign. The authors report this sign in a patient who actually has a double IVC. "CT angiography" with the technique described herein, will determine that the retroperitoneal structures demonstrated by CT are indeed vessels rather than enlarged nodes or adrenal masses.
Twenty patients were prospectively studied by computed tomography (CT) before and after undergoing translumbar aortography (TLA). Changes indicative of retroperitoneal bleeding were depicted by CT in all 20 patients despite the predominantly small size of the hematomas. CT scans obtained within two hours after TLA demonstrated: (a) thickening of the diaphragmatic crura, (b) enlargement of the left psoas muscle, and (c) obscuration of the aortic outline by soft-tissue density. Follow-up scans at 24 hours (10 patients) and one week (3 patients) revealed marked decrease in abnormalities, suggesting rapid resorption of the hematoma.
An alternate technique of performing lower extremity venography is described for use in patients in whom injection into a superficial vein of the foot is not possible.
Explore the source record for details and available documents.
The influence of contrast material on renal venous renin activity was evaluated in a prospective study of 20 hypertensive patients. It is concluded that the absolute values of renal venous renin activity are either unchanged or unpredictably changed after injection of contrast material. The renal venous renin activity ratios seem to be less valid than the absolute values in predicting the significance of renal vascular or parenchymal disease.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The sixth reported case of duodenal diverticulitis diagnosed preoperatively is presented. A review of the literature indicates that most duodenal diverticula are asymptomatic and require little special management. Rarely, acute inflammation can develop, and duodenal diverticulitis must be included in the differential diagnosis of all acute upper abdominal conditions, especially in the radiographic differential of emphysematous cholecystitis and retroperitoneal emphysema.