Biomedical subjects
Publications and source records attributed to M Korobkin.
Computed tomography has had a dramatic impact on the practice of uroradiology. The transverse image plane and excellent density differentiation allow more accurate diagnoses and often preclude the necessity for more invasive diagnostic tests or surgery. Refinements in equipment and diagnostic techniques promise further improvements in diagnosis and disease monitoring.
Six patients with small solid renal tumors were evaluated by computed tomography (CT). Two patients had renal oncocytomas, three had small renal cell adenocarcinomas, and one had separate foci of each of these tumors in the same kidney. We describe several features that may alert the clinician to the possible presence of oncocytoma. We found, however, that unless the dense central scar that can be seen in larger oncocytomas is visualized on CT (as was the case in one of our patients), differentiation between oncocytomas and renal cell carcinomas by CT is not possible.
Approximately 10% of patients undergoing computed tomography (CT) of the abdomen will have a pseudomass at the gastroesophageal junction. The technique and value of using the left lateral decubitus position for CT evaluation of the gastroesophageal junction is described.
Computed tomography (CT) of the neck has been primarily applied to the assessment of malignant disease with few reports describing its utility in benign conditions. The authors report 13 cases of cystic neck masses evaluated by CT. Pathological conditions included brachial cleft cyst, laryngocele, thyroglossal duct cyst, cavernous lymphangioma, necrotic lymphadenopathy, and asymmetric jugular veins. Computed tomography was helpful in correctly predicting the etiology by determining the exact location of these masses in relation to the normal anatomic structures in the neck.
Cystic hygromas of the neck can simulate other benign lesions and occasionally extend into the mediastinum. Using computed tomography, we were able to confirm the suspected diagnosis, exclude other diagnostic considerations, and clearly demonstrate absence of mediastinal extension.
Pancreatic pseudocysts are a well-known complication of pancreatitis and may occur in unusual locations. We report a case of a child with hereditary pancreatitis who developed a subcapsular pseudocyst of the left kidney. The constellation of findings of calcific pancreatitis and a left renal subcapsular fluid collection should raise the possibility of a subcapsular pseudocyst.
Although the clinical and radiographic manifestations of Thorotrast and its complications have been described, the computed tomographic (CT) appearance of Thorotrast deposition in the abdomen is less well known. Thorotrast produces a characteristic opacification of the liver, spleen, and abdominal lymph nodes. We report two cases of patients with Thorotrast-induced angiosarcoma of the liver detected by CT. Computed tomography in both cases demonstrated space-occupying lesions in the liver, which were readily detectable because of distortion of the Thorotrast-produced opacification.
Retroperitoneal hemorrhage caused by a renal tumor is usually due to a renal cell carcinoma or angiomyolipoma. The authors report a case of computed tomographic (CT) demonstration of renal metastases from choriocarcinoma with an associated perinephric hemorrhage. The CT features indicated the acute nature of the hematoma and its confinement within the extracapsular compartment of the perirenal space.
Although the potential for splenic injury during left sided thoracentesis or percutaneous renal biopsy is well known, its occurrence has been rarely reported. In a 1 year period we used computed tomography to detect acute splenic, perisplenic, and intraperitoneal hemorrhage in three patients after percutaneous diagnostic and therapeutic procedures in the lower chest and upper abdomen. One patient was asymptomatic, the second developed left upper quadrant pain, and the third required emergency splenectomy.
Conventional radiographic assessment of the patellofemoral joint (PFJ) is often unsatisfactory for a variety of technical and theoretical reasons. Using a simple device designed to allow easy and reproducible control of knee flexion, we used computed tomography (CT) to evaluate the PFJ in 10 normal volunteers and five patients with a history suggestive of recurrent subluxation or dislocation of the PFJ. At full extension of the knee the patients with a history of malalignment showed an abnormal patellar centralization and tilt compared with those of the normal volunteers. The abnormalities were absent or less pronounced on images obtained at 20 and 45 degrees of knee flexion.
The CT findings of two cases of primary lymphedema of the lower extremities are presented. CT showed a coarse, nonenhancing, reticular pattern in an enlarged subcutaneous compartment. CT excluded the diagnosis of secondary lymphedema from an obstructing mass by demonstrating a normal retroperitoneum and pelvis. The CT findings are correlated with pedal lymphangiograms.
Chest computed tomography (CT) is often used to detect and monitor pulmonary nodules in children undergoing chemotherapy for underlying sarcoma. Three children underwent resection of nodules which persisted during chemotherapy. In two children, all resected nodules were benign; in the other, a mixture of benign and malignant nodules was found. Our findings suggest that nodular scar formation after successful eradication by chemotherapeutic agents may be a mechanism for the persistence of pulmonary nodules. It should not be assumed that persistence of pulmonary nodules on CT after appropriate chemotherapy indicates inadequate response.
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Computed tomography (CT) has a reported accuracy of 45%-97% in assessment of patency of coronary artery bypass grafts. Dynamic CT was done in 26 patients (47 grafts) with recurrent cardiac symptoms after graft surgery. Although CT was 79% accurate (with selective angiography as the standard), the authors do not believe that it provides sufficient information for the assessment of symptomatic patients. Four patients had high-grade stenoses in their grafts, and 50% of patients had significant progression of atherosclerosis in their native coronary arteries. Neither of these conditions could be detected by CT. The clinical contribution of CT will probably be greatest for routine screening of asymptomatic patients soon after operation. Technical problems with CT scanning for graft patency are discussed.
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Computed tomography (CT) provides a unique method of evaluating abnormalities of the larynx by virtue of its cross-sectional images. Several reports have demonstrated its utility in staging laryngeal carcinoma and defining the extent of injury in cases of laryngeal trauma [1-8]. In order to appreciate subtle abnormalities of the larynx, a thorough understanding of the normal structures in this small anatomic area is crucial. Although previous studies have defined the normal CT anatomy of the larynx, many of the CT-anatomic correlations of the normal larynx used earlier-generation CT scanners with relatively poor resolution or were limited to transaxial images [9-13]. We have correlated high-resolution transaxial, coronal, and sagittal CT in vivo images with line drawings displaying normal laryngeal anatomy. The exquisite anatomic detail apparent in these images provides a sound basis for understanding subtle abnormalities in pathologic cases.