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Biomedical subjects

V H Low

Publications and source records attributed to V H Low.

At least 37 records · Page 2Linked to original sources
PubMed1996

Malignant melanoma metastatic to the gastrointestinal tract.

Malignant melanoma, a common malignancy whose prevalence is increasing, represents 1-3% of cancers in the United States [1]. At autopsy, metastatic deposits to the gut are frequently found, but less than 9% of melanoma patients are diagnosed with gastrointestinal metastases while living [2]. Modern management includes aggressive surgical therapy to prolong survival and to palliate the disease [3]. Therefore, imaging of metastatic melanoma is clinically important to detect extent and determine whether the patient would benefit by surgery. Gastrointestinal metastases may manifest as mucosal or submucosal masses, serosal implants, or carcinomatosis [4]. They arise more commonly in the mesentery or distal small bowel than the proximal gastrointestinal tract or colon. The purpose of this essay is to illustrate the appearance of melanoma metastatic to the gastrointestinal tract on luminal contrast studies and on CT and to emphasize the importance of early investigation of gastrointestinal symptoms in a patient with a history of malignant melanoma.

Adult↗
PubMed1995

Systemic lupus erythematosus serositis.

The imaging appearances of a case of systemic lupus erythematosus, which manifested initially as a serositis, is described. Barium small bowel study showed segments of spiculation with tethering, angulation, and obstruction. On computed tomography there was ascites and segments of asymmetrical thickening of small bowel wall were observed. Laparotomy revealed extensive patchy serosal and peritoneal plaques but biopsy of these lesions did not lead to a definitive diagnosis. The diagnosis was made on the basis of marked elevation of antinuclear and anti-double stranded DNA antibodies.

Adult↗
PubMed1995

Case quiz.

Explore the source record for details and available documents.

Aortic Dissection↗
PubMed1995

Tuberculosis of the abdomen.

The diagnosis of abdominal TB is often difficult. A high index of suspicion is required, especially in the high-risk population. This article discusses the radiology of abdominal TB, stressing the importance of early diagnosis and treatment in order to obtain a favorable outcome.

Abdomen↗
PubMed1994

Calcified lymph node metastases in adenocarcinoma of the colon.

Radiologically demonstrable calcification has been described in a variety of primary tumours and metastatic deposits. Dystrophic calcification in retroperitoneal lymph nodes may occur in malignant lymphoma or metastatic carcinoma, most often after radiotherapy or chemotherapy. However, de novo calcification in retroperitoneal lymph node metastases from carcinoma are very rare. Such a case is presented here.

Adenocarcinoma↗
PubMed1994

Mucinous cystadenoma of the appendix with unusual sonographic appearances.

A case of an appendiceal cystadenoma resulting in a large mucocele in a 35 year old man presenting with abdominal pain is reported. On ultrasonography, an unusual appearance of strand-like layers of varying echo-texture suggesting a solid lesion was seen. On computed tomography, calcification and contrast enhancement of the rim was noted. The spectrum of imaging appearances of appendix mucoceles is reviewed.

Adult↗
PubMed1994

Diagnosis of gastric carcinoma: sensitivity of double-contrast barium studies.

OBJECTIVE: This study was undertaken to determine if the double-contrast upper gastrointestinal examination is a sensitive technique for diagnosing gastric carcinoma. MATERIALS AND METHODS: We retrospectively reviewed the radiographs of 80 patients with pathologically proved gastric carcinoma who had double-contrast barium studies of the upper gastrointestinal tract between 1985 and 1992. The original radiologic reports were also reviewed to determine if the lesions had been detected on radiographic studies and if a diagnosis of gastric carcinoma had been made or suspected on the basis of the results. Subsequently, radiologic records were reviewed to identify all patients who had double-contrast studies during a recent 1-year period for whom endoscopy was recommended for evaluation of possibly malignant lesions. Pathologic records were also reviewed to determine the number of true-positive and false-positive cases in this group. RESULTS: The lesions were detected radiographically in all 80 patients. In one case, however, the lesion had been missed on another barium study 2 years earlier, so that we actually detected 79 (99%) of the 80 gastric carcinomas. Malignant neoplasm was diagnosed or suspected in 77 cases (96%). In two of the three cases in which gastric carcinoma was not mentioned in the radiologic reports, the lesion caused gastric outlet obstruction. A separate 1-year retrospective review revealed that only 54 (3.5%) of 1546 patients who had double-contrast studies during this period were referred for endoscopy because of radiographic findings that were equivocal or suggestive of tumor. The presence of gastric carcinoma was confirmed by endoscopy or surgery in 10 (19%) of those 54 patients. CONCLUSION: Our findings indicate that the double-contrast upper gastrointestinal examination is a sensitive technique for the diagnosis of gastric carcinoma. Furthermore, a high sensitivity can be achieved without having an inordinate number of patients undergo unnecessary endoscopy.

Adenocarcinoma↗
PubMed1993

Contrast evaluation of the pharynx and esophagus.

Swallowing requires the coordinated action of the alimentary tract from the oral cavity to the gastroesophageal junction. Any structural or functional abnormality along this pathway will interfere with swallowing. The "barium swallow" or pharyngoesophagogram requires examination of the oral cavity, pharynx, esophagus, and gastric cardia.

Contrast Media↗
PubMed1992

Anomalous peritoneal folds of the duodenum--a normal variant simulating disease.

The double contrast barium meal appearance of four cases is presented where an anomalous peritoneal fold involves the duodenum. This fold results in a characteristic smooth, extrinsic indentation upon the antero-superior surface of the duodenal cap. This normal variant should be differentiated from distortion of this region due to pathology such as peptic ulceration. Anomalous peritoneal folds which involve the duodenum (cystoduodenal ligament, cysto-gastrocolic ligament) are not believed to cause symptoms (1). However, the recognition of the deformity produced by these folds is important, requiring differentiation from pathological changes.

Barium Sulfate↗
PubMedDate not supplied

Hepatic angiomyolipoma.

The imaging and pathological appearances of a hepatic angiomyolipoma are presented. On ultrasound (US), the mass was well-defined and echogenic. On computed tomography (CT), the lesion appeared of soft tissue density with peripheral foci of lower density. The case illustrates the difficulty of detecting the fatty content of a tumor by CT when the fatty content represents only a small portion of the lesion. Fine-needle aspiration (FNA) cytology and needle biopsy did not yield diagnostic material, and the tumor was resected.

Adult↗
PubMedDate not supplied

Colonic pseudo-obstruction: value of prone lateral view of the rectum.

BACKGROUND: Collection of fluid within the rectum of patients with gas-distended bowel can simulate as obstructive lesion. METHODS: In 12 patients with suspected distal colonic obstruction on plain radiographs, we obtained 2 additional films comprising a right lateral decubitus view of the abdomen followed by a prone lateral view of the pelvis. RESULTS: Significant gaseous distension of the rectum was achieved in 75% of the 8 patients with pseudo-obstruction. Gaseous filling of the rectum did not occur in any patient with a structural obstructive lesion. CONCLUSIONS: In the appropriate clinical setting this approach could exclude the presence of obstruction and avoid unnecessary barium enemas in the majority of patients with colonic pseudo-obstruction.

Aged↗
PubMedDate not supplied

Retrograde cholangiography of malignant biliary strictures: spectrum of appearances and pitfalls.

PURPOSE: To evaluate retrograde cholangiograms, explore the morphology of malignant biliary strictures, and determine if there are any features that may indicate a specific diagnosis. MATERIALS AND METHODS: The retrograde cholangiograms of 514 patients were reviewed. Cases with clinical follow-up and subsequent studies indicating malignant involvement of the biliary tree were identified. Fifty patients were found. RESULTS: Carcinoma of the pancreatic head was the most common disease with 21 patients in this group. The morphology of the bile duct at the point of involvement was nonspecific comprising shouldered intrinsic appearing lesions as well as tapered in other cases. Pancreatic duct dilatation was a relatively specific finding occurring in 80% of this group. Other malignancies to involve the bile ducts included cholangiocarcinoma, metastases, ampullary carcinoma and gallbladder carcinoma. As with pancreatic carcinoma, the morphology of the lesion (e.g., shouldered versus tapered, length of stricture, severity of proximal dilatation) did not aid in the specific diagnosis of the pathology. Illustrative cases are presented where the morphology was unexpected for the eventual diagnosis (e.g., simulating intraluminal filling defects). CONCLUSION: The cholangiographic appearance of a biliary stricture is usually not helpful in the specific diagnosis of the underlying etiology. Carcinoma of the pancreatic head may be suspected if pancreatic duct dilatation is also found. This article presents some unusual cholangiographic pitfalls that were identified, which initially distracted from the ultimate diagnosis.

Adult↗
PubMedDate not supplied

The normal retrograde cholangiogram: a definition of normal caliber.

PURPOSE: To evaluate normal retrograde cholangiograms to determine a normal range of ductal calibers and identify its variation with age. MATERIALS AND METHODS: The retrograde cholangiograms of 136 patients (age range: 17-84 years; mean age 49.8 years +/- 17.3 [standard deviation]) with clinical follow-up and subsequent studies suggesting normal biliary trees were evaluated. Patients with previous cholecystectomy, choledocholithiasis, or pancreatitis were excluded. Common bile duct (CBD) and common hepatic duct (CHD) sizes were measured. RESULTS: Measurements uncorrected for radiographic magnification of CBD revealed a mean of 8.5 mm +/- 2.7 mm [standard deviation] and CHD had a mean of 8.1 mm +/- 2.6 mm. There was an increase in CBD caliber by 0.5 mm per decade of increasing age (p < 0.001) and an increase in CHD caliber by 0.35 mm per decade of age (p < 0.01). CONCLUSION: The range of normal cholangiographic bile duct caliber is wide and a CBD caliber of 13.9 mm occurs at the top of this range (mean plus two standard deviations). There is a small but statistically significant trend of ductal dilatation with advancing age.

Aging↗
PubMedDate not supplied

The oblique pharyngogram: value in the assessment of dysphagia.

BACKGROUND: To evaluate the diagnostic value of oblique views of the pharynx in patients with dysphagia. METHODS: One hundred thirty-three patients with symptoms referable to the cervical region underwent pharyngoesophography that included views of the pharyngoesophageal junction filmed at three frames per second and spot films of the pharynx obtained in distended frontal, lateral, and both oblique projections. Examination was completed with assessment of the entire esophagus and gastric cardia. RESULTS: The oblique views identified abnormalities not shown on the standard views in 5% of patients. The oblique views proved useful in 12%, where the lower pharynx was obscured in the lateral projection by large shoulders, and in 18% to assess the valleculae when this region was obscured by the occiput and mandible in the frontal projection. In 12%, the oblique views proved useful in demonstrating normal structures when artifacts raised the possibility of lesions on the standard projections. In 10%, poor technique impaired visualization of pharyngeal structures on the standard projections, but repeat swallows in the oblique projections proved adequate to assess these regions. Three (27%) of the 11 cases of cervical esophageal webs were best seen on oblique views, and in another three patients the webs were visible only on oblique views. CONCLUSIONS: Oblique views are of value in the assessment of the pharynx. There will be instances when the standard projections are inadequate, and these alternative views will complement the evaluation of this region. The addition of oblique views will sometimes improve the confidence of the interpretation of normality or assist evaluation of the extent of an abnormality.

Administration, Oral↗
PubMedDate not supplied

Vaginal opacification during defecography: utility of placing a folded gauze square at the introitus.

We evaluated the value of placement of a folded gauze square into the urogenital introitus to improve vaginal opacification in 90 patients who underwent defecography. Of the 50 patients who retained the gauze in the introitus, 96% demonstrated excellent or good vaginal opacification. By contrast, only 75% of the 40 patients who lost the gauze during the study were able to achieve the same level of opacification. This difference was shown to be statistically significant (p < 0.002), suggesting that placement of a folded gauze square in the introitus limits loss of contrast from the vagina, which improves vaginal opacification.

Adult↗