A simple technique for double-contrast esophagography is described. The technique involves successive swallows of an excellent coating barium mixture and water to create the double contrast effect. Clinical and radiologic situations in which double contrast esophagography have proven helpful include: (a) the detection of small esophageal tumors; (b) delineation of the morphologic features of neoplastic and inflammatory disease; and (c) assessment of the total vertical extent of esophageal disease. Accurate and/or confident diagnosis is aided considerably with double-contrast esophagography.

HomeRadiologyVol. 182, No. 1 PreviousNext ArticlesJoan L. Ezekiel, MD1944-1991VIDYA KAMATH, HARVEY M. GOLDSTEINVIDYA KAMATH, HARVEY M. GOLDSTEINVIDYA KAMATHHARVEY M. GOLDSTEINPublished Online:Jan 1 1992https://doi.org/10.1148/radiology.182.1.289-bMoreSectionsPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookXLinked In Article HistoryPublished in print: Jan 1992 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 182, No. 1 Metrics Altmetric Score PDF download

HomeRadiologyVol. 175, No. 3 PreviousNext ArticlesBarney K. Lovell, MD1911-1989HARVEY M. GOLDSTEINHARVEY M. GOLDSTEINHARVEY M. GOLDSTEINPublished Online:Jun 1 1990https://doi.org/10.1148/radiology.175.3.881-bMoreSectionsPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookXLinked In Article HistoryPublished in print: June 1990 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 175, No. 3 Metrics Altmetric Score PDF download

HomeRadiologyVol. 172, No. 1 PreviousNext ArticlesWilliam M. Leavenworth, MD1914-1988HARVEY M. GOLDSTEINHARVEY M. GOLDSTEINHARVEY M. GOLDSTEINPublished Online:Jul 1 1989https://doi.org/10.1148/radiology.172.1.289-aMoreSectionsPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookXLinked In Article HistoryPublished in print: July 1989 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 172, No. 1 Metrics Altmetric Score PDF download

The clinical course of 19 patients with pancreatic phlegmon, as diagnosed by computed tomography (CT) and clinical criteria, was assessed retrospectively and compared to that of eight patients with pancreatic abscess diagnosed either at surgery or with percutaneous aspiration. Controls consisted of 55 patients with uncomplicated acute pancreatitis without CT scans and 11 patients with acute pancreatitis in whom CT scans were negative or only consistent with acute pancreatitis (no phlegmon). The age, sex, and presumed etiology of the pancreatitis were not significantly different in the four groups. Patients with phlegmon had a higher incidence of severe pancreatitis as defined by Ranson's criteria, presence of an abdominal mass, as well as a longer duration of fever, abdominal pain and leukocytosis than controls without CT scans. With the exception of a palpable abdominal mass and fever lasting over five days, the results were similar when comparing the phlegmon group and controls with CT scans, although the severity of the disease and prolonged abdominal pain tended to be increased in the former patients. There was no statistically significant difference in clinical or laboratory criteria between the phlegmon and abscess groups, although the latter group had longer hospital stays and periods with no oral intake (npo). Management of patients with phlegmon tended to include TPN, longer npo periods, antibiotics, and longer hospital stay than in controls without CT scans. Controls with CT scans were managed similarly to the phlegmon group because of prolonged amylase elevation and abdominal pain, Percutaneous aspiration was successful in differentiating abscess from phlegmon in five of six cases. Major complications were rare in the phlegmon group and spontaneous resolution was the rule. Pancreatic phlegmon is a distinct clinical/radiologic entity which may be very difficult to differentiate clinically from pancreatic abscess. Early percutaneous thin-needle aspiration of the inflammatory mass (under CT guidance) seems to be the diagnostic procedure of choice. Management is nonsurgical unless complications arise. The role of TPN and antibiotics is unknown, and controlled studies of these therapeutic approaches in pancreatic phlegmon are needed.

Diverticulitis of the right colon is a relatively uncommon disease that usually mimics acute appendicitis. Most patients are operated on early, and a barium enema is not commonly obtained. Five cases with barium studies are presented. In four of the five cases an intramural mass effect and evidence of involvement of the colonic wall were present. Diverticula of the right colon were found in all five patients. If the diagnosis is made without surgery, medical therapy is usually successful.

A variety of benign conditions can affect the oesophagus, both primarily and secondarily. Traditionally fluoroscopic oesophagography and endoscopy have formed the mainstay for investigating oesophageal diseases. Increasing use of cross-sectional imaging means that many such diseases and their thoracic complications are now detected at computed tomography (CT), which is very often the first imaging tool. This review describes the CT manifestations of a range of benign oesophageal conditions and discusses the role of CT in their evaluation.

A comparison of scintigraphy, ultrasonography, and computed tomography (CT) in 94 proven patients with clinically suspected liver disease is reported. CT proved to be the most accurate in detecting masses and assessing the complete extent of intrahepatic disease. The most reliable combination was CT and scintigraphy. The specific advantages and disadvantages of each method are discussed. The diagnostic scheme followed in the imaging evaluation of an hepatic mass in our clinical practice is discussed.

Several common and/or misleading hepatic sonographic pseudolesions which may closely simulate pathological conditions are presented. All were caused by anatomical variants or scanning artifacts. Care should be taken to avoid mistaking such findings for true liver disease.

Five cases of extension of renal carcinoma into the inferior vena cava were detected using gray scale ultrasonography. Two different ultrasonographic appearances reflecting the intracaval tumor were observed. Four patients had one or two intraluminal echogenic nodules or thrombi, and the fifth case manifested generalized caval dilatation with innumerable diffuse low amplitude echoes emanating from the lumen. The role of ultrasonography in the complete evaluation of the patient with renal carcinoma is discussed, and the ultrasonographic features of intracaval tumor are demonstrated.

Ultrasonic characteristics of 21 adrenal neoplasms (19 patients) examined by gray scale ultrasonography are reviewed. The significance of the adrenal-renal cleavage plane is discussed. In our experience the cleavage plane only has definite localization value when it separates the adrenal gland from the kidney on all ultrasonographic sections. Compression of the posterior wall and/or anterior displacement of the inferior vena cava was seen in about two-thirds of the right adrenal tumors. The difficulty in examining left adrenal masses is emphasized. Ultrasonography has proved to be an excellent screening procedure for adrenal tumors.

Seven patients with necrotic liver metastases were evaluated by computed tomography. The metastases demonstrated low attenuation areas varying from a small central portion to the entire lesion. Other findings included mural nodules and fluid-fluid levels. Possible etiologies for necrotic metastases are presented and their differential diagnosis is discussed.

One hundred and eight ultrasonographic examinations of the abdomen and pelvis in 89 patients with malignant melanoma were reviewed. Forty of these patients were found to have metastatic disease demonstrated by this new diagnostic modality. The varied ultrasonographic manifestations of melanoma are illustrated. Its use in staging and evaluating therapy is stressed. Cancer 42:2529–2533, 1978.

Three patients, each with two synchronous esophageal carcinomas demonstrated radiologically, are presented. The importance of complete esophageal evaluation in patients with one obvious tumor of the esophagus is emphasized. Assessment of the full extent of disease in such cases directly affects treatment planning.

Ultrasonography was performed in the prone and supine positions in six patients with neoplasms in the tail of the pancreas. The masses were either not apparent (three cases) or less well visualized on the supine scans. The value and indications of the prone position in the ultrasonic evaluation of masses in this portion of the pancreas are documented. Prone scanning is particularly useful when malignant ascites interferes with pancreatic visualization in the supine position.

Berk, Robert N. MD; Ferrucci, Joseph T. Jr. MD; Goldstein, Harvey M. MD; Leopold, George R. MD; Loeb, Peter M. MD; Parkey, Robert W. MD; Stanley, Robert J. MD Author Information

The role of ultrasonography in the evaluation of 12 patients who had previously undergone nephrectomy for renal carcinoma is discussed. Ultrasonography is a useful, noninvasive means of evaluating such patients for recurrence of disease. The ultrasonographic features of retroperitoneal recurrence and a potential diagnostic pitfall of bowel loops in the renal bed are emphasized.