Selective left subclavian arteriography and thoracic aortography were performed via the translumbar approach. The resultant studies were technically and diagnostically satisfactory. This approach can be used when the femoral and axillary arteries are not available for vascular access.

Sixty-five sites of arterial gastrointestinal hemorrhage in 63 patients were managed with transcatheter therapy. Arterial vasopressin infusion was attempted primarily for all but three sites; embolization was used in these cases and in those for whom vasopressin infusion failed to control bleeding. The results obtained suggest that this regimen, that is, primary vasopressin infusion with embolization reserved for infusion failures or contraindications, is more effective for control of arterial gastrointestinal hemorrhage than the use of either method alone. The role of primary embolization for control of this type of bleeding may need reassessment.

During a recent four month period, clinical and radiologic evaluation of four patients with inflammatory disease in the neck or upper mediastinum was performed. All patients admitted to attempting intravenous narcotic injections in the neck. Three patients were examined by computed tomography in addition to plain films and one patient was also examined angiographically. Complications in this group of patients included cellulitis, abscess, venous thrombosis and pneumothorax. Computed tomography appears to be the imaging modality ideally suited to the evaluation of these abnormalities.

Cervical abscess and internal jugular vein thrombosis occurred in a 36-year-old man with a history of drug abuse. Computed tomography (CT) and angiography correctly identified the pathologic abnormalities that were surgically confirmed. We stress the use of CT in the evaluation of this condition.

Percutaneous catheter biliary decompression was performed in 42 patients with obstructive jaundice. Internal drainage was accomplished in 27 patients (64.3%), and external drainage in 15 patients (35.7%). Serum bilirubin levels decreased at a mean rate of 1.4 mg/dl/day. Tissue diagnosis was obtained by percutaneous aspiration biopsy in nine patients (21.4%). Complications occurred in 10 patients (23.8%): septic shock, two; bilious pleural effusion, one; hepatic subcapsular hematoma, one; sepsis, six. There was one death related to the procedure. The catheter management problems encountered included pain, catheter dislodgement or migration, lumen occlusion, and external bile leakage.

Malignant pleural mesothelioma is a rare tumor. Although the chest film findings of pleural mesothelioma are well described, there are few descriptions of the findings of computed tomography (CT). This report describes the CT findings in five cases of pleural mesothelioma. In each case the CT showed an extensive, irregular, pleural-based mass surrounding the lung, spreading into the fissures, and extending into the mediastinum. In two cases there was also extension into the contralateral chest, and in one case each there was extension into the abdomen and chest wall. In each case the chest radiographs underestimated the extent of disease, when compared to CT. When an irregular, pleural-based mass involving most of the hemithorax is identified on CT, the diagnosis of mesothelioma can be suggested and at the same time the extent of the tumor may be evaluated. This is important because the diagnosis of mesothelioma is difficult and because treatment and prognosis may depend on the extent of the disease.

A patient with fever and anemia was found to have a left suprarenal mass on excretory urography. Computed tomography (CT) accurately delineated abscess formation in the perinephric space external to the renal capsule. A perforated carcinoma of the transverse colon was the underlying cause of the abscess. Pertinent radiological and CT findings are presented. The value of CT in the analysis of disease processes adjacent to the kidney is emphasized.

Thirty-six patients with aortoiliac reconstruction were studied by magnetic resonance imaging (MRI) to determine the diameter, baseline signal, and subsequent magnetic signal characteristics of postoperative periprosthetic collection (PPC). Our study confirmed the presence of PCC in most cases (32/36). The diameter was significantly (p <0.05) correlated with the type of disease being treated, the type of proximal anastomosis created, and whether or not drainage and postoperative transfusion were used. PPC usually disappeared within 3 to 6 months postoperatively. Modifications of magnetic signals T1 and T2 require approximately the same amount of time to diminish. During follow-up investigations in this series, there was one case of prosthetic infection characterized by the persistence of PPC and a strong T2 signal 6 months after surgery, the latter corresponding to incomplete or delayed healing. The MRI aspects of normal healing of aortic grafts were analyzed to correctly interpret the MRI aspects of complications in surgery of the aorta.

A case is presented in which closed head and chest trauma caused a pseudoaneurysm at the base of the left common carotid artery. There were no significant injuries apparent on clinical evaluation. A strikingly abnormal chest radiograph prompted arteriography, which was diagnostic. A mechanism for the injury is postulated.

Two cases of pulmonary lymphatic opacification during lymphangiography in the presence of a normal thoracic duct are reported. The most likely route of filling of the pulmonary lymphatics in the lower lobes is by reversed flow from the thoracic duct through the inferior pulmonary ligament lymphatics. Retrograde flow from the bronchomediastinal trunk is unlikely.

The hemodynamic effects of intra-material prostaglandin E1 (PE1) administered via the angiographic catheter were evaluated in 14 patients. Blood flow in the superior mesenteric artery (SMA) after PGE1 infusion was compared with control SMA blood flow as measured by the "spillover" angiographic reflux method, using a specially designed injector/film-changer system. In all patients, SMA blood flow increased by more than 50% and visualization of the SMA and portal vein was enhanced.

A patient had an ascending colon carcinoma in a right inguinal hernia sac, the first such instance to be reported. A second patient had a left colon carcinoma in a left inguinal hernia sac. Both patients had gastrointestinal symptoms and anemia which warranted a barium enema.

Late complications at the repair site of coarctation of the aorta include aneurysms and persistent coarctation. Aneurysms are usually due to failure of the surgical anastomosis and can occur many years after repair. Continued aortic coarctation may be due to either repair failure or failure of the anastomotic site to grow with the patient. Three cases are presented and the literature reviewed.

Thirty-one cases of renal vein thrombosis (RVT) were reviewed retrospectively for clinical laboratory, and radiographic findings. An underlying renal disorder was present in 28 cases, absent in only 3. This supports other evidence that RVT is usually a complication of renal disease rather than a primary event, and that nephrotic syndrome may be due to renal disease rather than RVT. The findings also confirmed the large spectrum of urographic appearances in RVT, and were used as a basis for developing specific and liberal indications for renal venography.

Renal malakoplakia with renal vein thrombosisRA Clark, MA Weiss, DP Colley and GM WyattAudio Available | Share

Evaluation of the dimensions of the spinal canal is difficult to achieve by conventional techniques. CT scanning permits accurate evaluation of the canal dimensions as well as comparison with levels above and below the site of injury. This report presents 3 cases of vertebral fractures in which narrowing of the spinal canal was demonstrated by CT.

Nonvisualization of a kidney in an elderly man was investigated by computed tomography (CT). Simple low lying ureteral obstruction was excluded, multiple pathologic abnormalities were identified and causes for the nonvisualization are postulated. This case report demonstrates the important effect CT scanning produced on the clinical management of the patient in question.