Biomedical subjects
Publications and source records attributed to M J Shortsleeve.
When radiography is performed in patients with mitral regurgitation, cardiogenic pulmonary edema is a typical finding; however, asymmetric pulmonary edema has also been reported. We describe the case of a patient in whom mitral valve regurgitation caused isolated pulmonary edema in the right upper lung. We include a discussion of pulmonary edema in conjunction with mitral regurgitation.
Esophageal intramural hematoma can mimic other causes of chest pain. When the patient is known to have coronary artery disease, the diagnosis may be difficult. Moreover, the course may be complicated and may harm the patient if antiplatelet drugs, thrombolytics, and anticoagulants are used. The presence of odynophagia should alert the clinician to the possibility of an esophageal origin, even in a patient with known coronary artery disease. We present a case in which early recognition of the clinical presentation prevented potential iatrogenic complications.
OBJECTIVE: To better define the effectiveness of abdominal computed tomographic scanning (ACTS) in adult patients with suspected appendicitis. DESIGN: Retrospective analysis. SETTING: A community teaching hospital. PATIENTS: Ninety-seven patients with appendicitis in the differential diagnosis, whose clinical findings were insufficient to perform surgery or to discharge from the hospital, during a 14-month period. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Accuracy of ACTS, rate of appendectomies that show no appendicitis (negative appendectomy rate), and frequency of ACTS as a definitive diagnostic test. RESULTS: Forty-nine of the 50 patients with appendicitis were correctly diagnosed by ACTS. Forty-three of the 47 patients without appendicitis were correctly diagnosed by ACTS. Positive predictive value was 92%, negative predictive value was 98%, and accuracy was 96%. The ACTS group had a negative appendectomy rate of 5.8% (3/52), lower than the hospital rate of 14% for the preceding 3 years. The ACTS established an alternative diagnosis in 16 patients, allowed 10 other patients to be discharged early or not admitted, and was the critical diagnostic test in 30 of the patients with appendicitis. Therefore, the ACTS played a definitive role in the treatment of 56 (57.7%) of the 97 patients. CONCLUSIONS: The ACTS was an accurate test in the diagnosis of appendicitis and was of significant benefit in 57.7% of the patients studied. However, it was difficult to predict which patients were most likely to benefit. Expanded selective use of ACTS for patients with clinically indeterminate appendicitis may result in a lower negative appendectomy rate and fewer patient admissions for observation.
This case report describes an accidental ingestion of a gold dental inlay prosthesis that became lodged in the appendix. A nonsurgical approach was pursued because this blunt foreign body posed a minimal perforation risk. A second opinion for an elective appendectomy was chosen by the patient until a preoperative abdominal film 20 days after ingestion documented the passage of the foreign body into the colon. The patient remained asymptomatic throughout the 3-week course. This report represents the first case to clearly document an appendiceal foreign body that spontaneously passed into the colon. We suggest that patients with blunt foreign bodies within the appendix may be treated conservatively under close medical supervision.
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OBJECTIVE: In 1990, we described a combination therapy that uses glucagon, an effervescent agent, and water to relieve acute esophageal food impaction. The initial trial showed relief of the obstruction in 12 of 16 cases without complication, so we continued the series to determine the safety and effectiveness of this technique. SUBJECTS AND METHODS: Between July 1987 and August 1993, a prospective trial consisting of 43 patients with 48 episodes of acute (less than 24-hr duration) food impaction in the distal two thirds of the esophagus were identified with either a barium or water-soluble contrast agent swallow. Subsequently, we attempted to relieve the obstruction by using 1 mg of IV glucagon, an effervescent agent, and water. A water-soluble esophagogram was obtained immediately in all cases to determine the response to the therapeutic intervention and to look for any complication such as perforation. RESULTS: The combination therapy resulted in the clearance of food obstruction in 33 (69%) of 48 attempts. One complication, a minor mucosal laceration, occurred after two unsuccessful treatments. A lower esophageal ring was the single most common abnormality identified (n = 24). The average width of rings in the successful cases was 15.4 mm and the average in the unsuccessful cases was 13 mm. Other underlying causes of obstruction were esophagitis and stricture. CONCLUSION: Our experience with the use of glucagon, an effervescent agent, and water to relieve acute esophageal food impaction indicates that the technique is highly successful and that serious complications are rare.
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The authors report the clinical and radiographic findings in five otherwise healthy male patients with herpes esophagitis who had no underlying immunologic problems. The patients all presented with onset of acute odynophagia after a flulike prodrome of fever, sore throat, or myalgias. In all five patients, double-contrast esophagograms revealed innumerable punctate or linear areas of ulceration, predominantly located in the midesophagus near the level of the left main bronchus. Four patients received viscous lidocaine and antacids, and one patient, intravenously administered acyclovir. All five patients had an acute, self-limited illness with complete resolution of symptoms 10-12 days from the time of presentation. It is concluded that, if the characteristic clinical prodrome is present in patients with typical findings on double-contrast esophagograms, such patients can receive conservative treatment without need for endoscopic intervention.
Small bowel involvement in rheumatoid arthritis is rare and is caused by vasculitis, which results in ulceration, perforation, and necrosis of the small bowel. The authors present a case of rheumatoid vasculitis associated with a small bowel stricture. The patient had a 3-week history of daily postprandial bloating, abdominal cramping, and vomiting. Barium study demonstrated partial small bowel obstruction. Pathologic examination of a resected segment of the small bowel proved that the stricture was caused by rheumatoid vasculitis. To the authors' knowledge, this is the first reported case of such an association in the radiology literature.
The authors report two cases of sulfadiazine-induced obstructive nephropathy that were diagnosed with ultrasound (US). Renal US demonstrated layered clusters of echogenic shadowing material--presumed to be sulfa crystals--which cleared when the crystalluria resolved. The authors conclude that renal US is helpful in diagnosing sulfa calculi and subsequent obstructive nephropathy.
A method is described for rapidly and accurately localizing microcalcifications in breast biopsy specimens to facilitate processing of appropriate tissue for microscopic examination.
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Hemorrhagic colitis due to Escherichia coli O157:H7 is a distinct clinical entity characterized by abdominal pain, watery diarrhea progressing to bloody diarrhea, and little or no fever. It has been reported to have a mortality as high as 31%. This form of colitis is not described in the radiologic literature. This paper describes the radiographic findings, and stresses the need for radiologists to be familiar with the disease in order to assist in early diagnosis. Key clinical and epidemiological features are reviewed.
Endoscopy is commonly accepted as the gold standard in the evaluation of neoplastic colonic disease. The procedure is used to confirm or exclude lesions detected on barium enemas, with the assumption that the endoscopist was successful in reaching the appropriate segment of the colon. We collected 18 cases, all with proved colonic neoplasm 2-8 cm in diameter that were detected by barium enema but overlooked on initial endoscopy. All of the lesions were relatively flat with little intraluminal protuberance. Histologic examination showed malignant foci in six of 11 tumors that were resected. In two of the other seven patients, unresected lesions progressed to advanced carcinomas. This experience suggests that a repeat barium enema is indicated when endoscopy fails to detect a colonic tumor suspected on barium enema examination.
Monooctanoin was infused through a cholecystostomy tube to dissolve multiple gallstones and re-establish cystic duct patency in a patient who was not a candidate for surgery.
Four patients with herpetic esophagitis were examined. In three of them, the presenting symptom was odynophagia. Early in the course of herpetic esophagitis, shallow round and oval ulcers were seen on barium esophagograms. Later, the ulcers filled with fibrinous exudate, forming nodular plaques that projected into the esophageal lumen. Although these findings are diagnostic of esophagitis, they are not specific for a herpes virus infection. The definitive diagnosis must be established by histologic examination, which demonstrates the cytopathic effect of the herpes virus infection within the squamous epithelium.
A nodular density seen at the posterior lung base on lateral chest radiographs proved to be normal bone in the spine. This nodule results from slight thickening of the bone at the superior aspect of the area where the two laminae join to form the spinous process.