Computed tomographic diagnosis of internal hernia.
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Abdomen, Acute↗
Biomedical subjects
W P Harbin
Publications and source records attributed to W P Harbin.
Metastatic disease and the nonspecific bone scan: value of spinal computed tomography.
Three cases are presented in which there were nonspecific bone scans and normal radiographs and in which spinal computed tomography (CT) demonstrated metastases. In each case, CT provided data that were crucial to patient management. Spinal CT offers important advantages, but further investigation is needed to determine whether it should be the procedure of choice in cases of scan-positive, radiograph-negative spinal foci of unknown etiology.
Bone and Bones↗
Unusual inflammatory processes involving the colon.
Six patients with unusual inflammatory lesions of the colon are presented. Several of these cases demonstrated unusual presentations of an unusual disease. The clinical and radiologic features (which together are of paramount importance in suggesting the correct diagnosis) are discussed. Important differential diagnostic considerations are listed.
Actinomycosis↗
Radiographic anatomy of the sacrospinalis muscle.
The lateral margin of the sacrospinalis muscle was visible on 24 of 100 supine abdominal radiographs. Its course is oblique, the reverse of that of the psoas. Findings on the plain radiograph and CT are correlated.
Adult↗
Fine-needle transhepatic cholangiography: reflections after 450 cases.
Fine-needle transhepatic cholangiography is widely accepted as the procedure of choice for direct opacification of the bile ducts. A 5-year experience with 450 cases provided the basis for refinements of clinical applications and technique leading to an improved duct opacification rate, 93%, and only a 4.8% complication rate. Fluoroscopic monitoring of needle puncture to insure a controlled placement is essential. Familiarity with the normal anatomic course of the biliary ducts permits gravity maneuvers and positional changes to better delineate the exact area and appearance of the obstructing lesion. Cholangiographic aids, glucagon and barium duodenography, improve accuracy of cholangiographic interpretation. An algorithm for integration of fine-needle transhepatic cholangiography with other methods, sonography and computed tomography, emphasizes its pivotal position in patients with suspected surgical obstruction of the biliary ducts.
Biliary Tract↗
Appearance of lymphomatous involvement of the mesentery by ultrasonography and body computed tomography: the "sandwich sign".
A characteristic appearance of lymphomatous involvement of the mesentery is demonstrated by ultrasonography and computed tomography. The presence of a lobulated confluent mass infiltrating the mesenteric leaves and encasing the superior mesenteric artery and veins producing a "sandwich-like" appearance is reported in seven patients with Hodgkin and non-Hodgkin lymphoma. Retroperitoneal adenopathy was present in all seven patients. In six, a correct prospective diagnosis was made and a major revision of therapeutic planning occurred. Laparotomy was deferred in three patients. The anatomy, pathophysiology, and clinical importance are detailed.
Adult↗
Transhepatic cholangiography: complicatons and use patterns of the fine-needle technique: a multi-institutional survey.
A multi-institutional survey of complications and use patterns of fine-needle transhepatic cholangiography (FNTC) was conducted, and the results were compared with those of transhepatic cholangiography using a large, sheathed needle and endoscopic retrograde cholangiopancreatography. Data were based on 2,006 procedures, including 293 from the authors' institution. The overall incidence of serious complications with FNTC was 3.4% (sepsis 1.40%, bile leakage 1.45%, intraperitoneal hemorrhage 0.35%, death 0.20%). The overall success rate was 97.8%; it was 99% when 12-14 needle passes were made, compared with only 95.5% when no more than 6 were made. It is concluded that 6 passes are not enough to exclude obstruction. One third of the patients with bile leakage had inadvertent puncture of the extrahepatic biliary tract. The pathogenesis of sepsis following FNTC is discussed and related to the author's recommendation of routine prior administration of ampicillin and gentamicin.
Aged↗
Percutaneous transhepatic biliary drainage: technique, results, and applications.
Internal catheter drainage was achieved in 46 of 62 consecutive patients (71.4%) undergoing percutaneous transhepatic biliary drainage (PTHBD). External drainage was achieved in 12 patients (19.3). Thus the overall success rate was 58 of 62 (93.5%). Postprocedural bilirubin levels returned to normal in 14 cases (22.5%), while bilirubin declines greater than 10 mg resulted in half the cases. Complications related to procedures occurred in three patients, although no deaths resulted. Late episodes of cholangitis were common (9/62 or 14.5%). Postprocedural care of the biliary drainage catheter included evaluation and management of acute biliary sepsis, persistent hyperbilirubinemia, electrolyte depletion, as well as catheter occlusion, bleeding, and dislodgement. PTHBD offers an effective new radiological alternative to surgical therapy of biliary obstruction.
Aged↗
Diagnosis of cirrhosis based on regional changes in hepatic morphology: a radiological and pathological analysis.
Transverse images of cirrhotic livers revealed specific morphological changes. The right lobe exhibited relatively greater shrinkage, while the caudate lobe underwent relative enlargement. Sonograms or CT scans of 25 proved cirrhotic livers, 25 normal livers, and 15 livers with diffuse disease other than cirrhosis were analyzed using a number of measurements and ratios to evaluate and quantify the frequency and possible diagnostic value of these alterations. Using the ratio of transverse caudate lobe width to transverse right lobe width, cirrhotic livers could be separated from noncirrhotic liver (both normal and abnormal) with a sensitivity of 84%, a specificity of 100%, and an accuracy of 94%. Another ratio revealed relative widening of the porta hepatis in 84% of cirrhotic livers, but this was not specific for cirrhosis. Pathological analysis of 11 cirrhotic cadaver livers revealed greater fibrosis in the right lobe than in the caudate lobe.
Adult↗
Significance of nonshadowing focal opacities at cholecystosonography.
Nonshadowing focal opacities within the gallbladder lumen are a frequent finding with cholecystosonography. This study describes a prospective analysis of 125 patients with this finding. In 36 patients surgical proof was obtained. It was found that nonshadowing echogenic foci in the gallbaldder can be separated into two distinct categories and that the incidence of gallstones can be determined for each. The categories are (a) nonshadowing echogenic foci less than 5 mm in size (incidence of gallstones is 81% for those patients coming to surgery) and (b) a fluid-fluid level or sludge (incidence of gallstones is less than 10% for those coming to surgery).
Cholelithiasis↗
Diagnosis of abdominal malignancy by radiologic fine-needle aspiration biopsy.
Fine needle aspiration biopsy in 100 consecutive patients with suspected abdominal malignancy yielded a positive diagnosis in 69 (82%) of 84 patients in cases ultimately proven to have cancer in the area sampled. Of 21 pancreatic cancers, 18 (86%) were detected; 24 (83%) of 29 liver lesions, usually metastases, were identifed; and 16 (78%) of 22 retroperiteonal masses, most frequently metastatic lymph nodes, were correctly diagnosed. Overall success rate for epithelial malignancy was 67 (85%) of 79 and far exceeded the yield in lymphomatous masses where two (40%) of five cases were detected. Several radiologic guidance methods were used including computed body tomography in 41%, ultrasonography in 45%, and fluoroscopy with or without conventional contrast agents in 14%. Complications were negligible. In a subgroup of 20 patients in whom a positive diagnosis was obtained, separate analysis of the cytologic specimen revealed that the first needle pass contained definitive material in 15 (75%) of 20 cases. The results confirm the effectiveness, safety, and wide applicability of fine-needle aspiration biopsy for nonsurgical confirmation of advanced or unresectable intraabdominal malignancy.
Abdominal Neoplasms↗
Nonoperative management of malignant biliary obstruction: a radiologic alternative.
Twelve patients with advanced malignant biliary obstruction were managed with a combination of sonography, percutaneous fine-needle aspiration biopsy, transhepatic cholangiography, and percutaneous biliary drainage. Excellent palliation of biliary obstruction was obtained in nine patients, four of whom are still living. Surgery was avoided in all cases, and a single episode of sepsis was the only complication. The literature indicates that surgical bypass procedures for malignant bile duct obstruction incur an average 20% operative mortality and provide only a 6 month mean survival. A combined radiologic approach offers an alternative to standard operative management of malignant biliary obstruction. When the cost-benefit ratios of operative vs. nonoperative management are considered, perhaps more patients should undergo radiologic management.
Adenoma, Bile Duct↗
Fallibility of exploratory laparotomy in detection of hepatic and retroperitoneal masses.
The recent wide availability of sonography and computed body tomography has added a new dimension to the diagnosis of abdominal masses. Recently in six patients exploratory laparotomy failed to reveal a mass demonstrated by preoperative cross-sectional imaging and subsequently confirmed in the postoperative period by reexamination with or without percutaneous needling. Three of the six patients had previous pancreatic inflammatory disease which may have limited the surgical evaluation of the retroperitoneum. Prior to the advent of cross-sectional imaging, there were few available direct means for discovering errors in intraabdominal surgical diagnosis. While exploratory laparotomy is obviously crucial for confirmation of abdominal masses, radiologists should be reminded that it is not infallible.
Adult↗
Internal hernia into Treves' field pouch. Case report and review of the literature.
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Adolescent↗
Nonvisualized gallbladder by cholecystosonography.
To further define the significance of gallbladder nonvisualization by cholecystosonography, we studied follow-up data on 25 consecutive patients in whom the gallbladder could not be identified despite adequate fasting. In one patient, intravenous cholangiography demonstrated a large gallbladder but no gallstones. In the 24 cases for which a pathoanatomic diagnosis was established, all but two had diseased gallbladders with obliteration of the lumen. This 88% accuracy for positive prediction confirms results of previous sonographic studies and matches the diagnostic significance of nonvisualization at oral cholecystography. We recommend oral cholecystography for all ultrasonic nonvisualized gallbladders for greater diagnostic accuracy when surgery is contemplated.
Cholangiography↗
Benign clear-cell tumor ("sugar" tumor) of the lung: a case report and review of the literature.
Benign clear-cell tumor of the lung is a rare, distinctive, primary neoplasm with unique histologic and electron microscopic features which may resemble metastatic renal-cell carcinoma. This tumor typically presents as an asymptomatic, peripheral, sharply rounded mass in the lung. Clinical recognition can prevent an unnecessary search for a primary malignant source.
Aged↗
The radiographic innominate lines of the scapular spine.
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Humans↗