RESUMEN

Inferior vena cava (IVC) aneurysms are extremely rare, with only 18 reported cases in the world literature. These aneurysms are categorized as acquired, congenital, or associated with arteriovenous fistulae. Thrombosis of an IVC aneurysm can lead to IVC syndrome characterized by massive lower extremity edema, pulmonary embolism, or even death. Therapeutic alternatives range from watchful waiting to operative resection. This report presents a case of an IVC aneurysm noted incidentally at the time of diagnostic computed tomography for the evaluation of blunt chest trauma following a motor vehicle collision. In addition, the classification, embryology, diagnosis, and management of this unusual clinical entity are reviewed.

Asunto(s)

RESUMEN

Two hundred fifty-six patients with hypoechoic lesions of the prostate found at transrectal ultrasound (US) were evaluated with prostate-specific antigen (PSA) study, digital rectal examination (DRE), and US-guided transrectal biopsy. Positive predictive values for cancer were calculated for transrectal US alone and in combination with DRE, PSA study, or both. Results were correlated with lesion size. The positive predictive value for transrectal US alone was 41%; this value increased to 61% if the patient had positive results from DRE, 52% if the PSA level was elevated, and 71% if both the DRE results and PSA level were abnormal. The positive predictive value for transrectal US fell to 24% if results of the DRE were normal, 12% if the PSA level was normal, and 5% if both DRE results and PSA level were normal. No cancers were detected in lesions 1.0 cm or smaller if DRE results and PSA level were normal. DRE and PSA study are valuable complements to abnormal transrectal US examinations. Biopsy of small suspicious lesions may not be indicated if results of both of the studies are normal.

Asunto(s)

RESUMEN

Percutaneous absolute ethanol injections and Nd:YAG laser ablations were performed bilaterally in canine prostates (N = 13) using transrectal ultrasound guidance. Seventy-one percent (10/14) of the ethanol injections produced an intraglandular focus of hemorrhagic necrosis. Associated morbidity of ethanol injections included necrosis of the external prostatic sphincter and mucosa of the urethra and bladder. Ninety-two percent (11/12) of the laser ablations produced intraglandular foci of thermal tissue damage, which had distinct margins of transition between necrotic and viable cells. The areas of ablation were well visualized by ultrasound and had minimal associated morbidity. The results of this study demonstrate the technical feasibility and low potential morbidity of transrectal ultrasound guided Nd:YAG laser ablations in the canine prostate.

Asunto(s)

RESUMEN

In the authors' experience, transrectal sonography has the ability not only to stage prostatic cancer accurately, but also to detect such lesions before they become palpable.

Asunto(s)

RESUMEN

Biplanar, transrectal ultrasound (US) guidance of needles was used in the transperineal biopsy of possibly malignant prostatic lesions in 80 patients (83 biopsies). A 22-gauge cytologic needle was used to locate and fixate the lesion, and aspiration specimens for cytologic and histologic evaluation were obtained (with 22- and 14-gauge needles, respectively). Twenty-one 19-gauge needle core biopsies were also performed. Forty-nine patients (61%) had histologically prove adenocarcinoma. The rate of cancer diagnosis was 53% with cytologic evaluation and 54% with histologic evaluation (combined yield, 61%). This included 34% of cancers less than 1.0 cm in diameter and 56% of those 1.0-1.5 cm. Thirteen of 23 (57%) of these lesions were nonpalpable or equivocal on digital rectal examination. These results suggest that transrectal US guidance of thin-needle biopsies is useful in diagnosing early prostate cancer.

Asunto(s)

RESUMEN

Over a 7-month period, from a total of 417 transrectal ultrasound (US) studies, 45 transperineal biopsies of the prostate were performed in the radiology department. Transrectal US guidance and local anesthesia were used. Twenty-two of 32 hypoechoic lesions, located within the peripheral zone tissue of the gland, were proved by histologic study to be cancerous. Hyperechoic lesions were all histologically benign hyperplasias. The patients experienced no major complications necessitating hospitalization or increased length of hospital stay as a result of the procedure.

Asunto(s)

RESUMEN

Adenocarcinoma of the prostate produces specific ultrasonic findings that can be used in diagnosis. We have examined 211 patients using transrectal ultrasound in both the sagittal and axial planes. Thirty-three carcinomas were detected, and 31 histologically confirmed; 24 by needle biopsy, six by transurethral resection, one by total prostatectomy, and two by the demonstration of distant metastases. On ultrasound, all of the carcinomas were less echogenic than normal prostate. All appeared to originate in the peripheral zone of the prostate and produced asymmetry of the gland. The majority of carcinomas in this series showed capsular involvement and ten penetrated and extended beyond the prostatic capsule. The results of this series indicate that transrectal ultrasound can be used to detect cancer of the prostate gland. Ultrasound demonstrated the extent of tumor involvement and enabled accurate staging of these cancers.

Asunto(s)

RESUMEN

Computed tomography (CT) in the evaluation of the sacroiliac joints was compared with conventional radiography in a double-blind study. CT did not increase the probability of detecting sacroiliitis. Because only a few patients were evaluated near the onset of their disease, the sensitivity of CT as compared with that of routine radiography in detecting early morphological changes remains undetermined. An inexperienced observer may find it easier to evaluate CT scans than conventional radiographs of the sacroiliac joint; however, with optimal images, an experienced radiologist does not need CT to evaluate the sacroiliac joint in clinical practice.

Asunto(s)

RESUMEN

Aneurysmal degeneration of gastroduodenal and pancreaticoduodenal arteries due to acute and chronic forms of pancreatitis is uncommon. Gastrointestinal hemorrhage secondary to these vascular lesions has been recognized in only 23 patients. Eight of these patients, including five with gastroduodenal and three with pancreaticoduodenal artery aneurysms, have been encountered at the University of Michigan Medical Center. Selective mesenteric arteriography provided the greatest diagnostic specificity. Computerized axial tomography was of discriminate diagnostic value in two patients. Seven of eight patients underwent surgical therapy: transcystic arterial ligation and external pancreatic pseudocyst drainage (four), arterial ligation with abscess drainage (two), and pancreaticoduodenectomy (one). Three patients died after operation from intraabdominal sepsis as well as delayed arterial hemorrhage. Earlier operative intervention, dictated by the patient's clinical status and relevant anatomic findings, may improve survival rates in this complex disease state.

Asunto(s)

RESUMEN

Computed tomography and angiography were performed in two patients with ileal carcinoid tumor and in one with retractile mesenteritis. In each instance, a low density right lower quadrant mass with small bowel displacement and thickened mesenteric neurovascular bundles was identified at CT. Superior mesenteric artery (SMA) angiography revealed contraction, kinking and irregularity of mesenteric branches in all cases, but specific histologic diagnosis was not established by angiography alone. Our preliminary experience suggests that SMA angiography may not always be necessary in the diagnosis of either carcinoid tumor or retractile mesenteritis.

Asunto(s)

RESUMEN

The diagnosis of multiple endocrine neoplasia type II (MEN-II) was made in 18 patients from 1966 through 1978 at the University of Michigan Medical Center. Eight patients had adrenal medullary disease. Seven had bilateral adrenal pheocyromocytomas (two with concomitant medullary hyperplasia) and one had a unilateral pheochromocytoma with contralateral medullary hyperplasia. No malignant or extraadrenal pheochromocytomas were found. Pheochromocytomas in patients with MEN-II are multiple and involve both adrenal glands. Adrenal venography is advocated as the primary diagnostic tool for localization of adrenal medullary disease in MEN-II patients.

Asunto(s)

Asunto(s)

RESUMEN

The complementary use of computed tomography and angiography in two patients with bleeding gastroduodenal artery pseudoaneurysm associated with pancreatic pseudocyst is presented.

Asunto(s)

Asunto(s)

RESUMEN

In two patients with retrocrural tumors, dissection of the tumors selectively into the posterior pararenal space was observed by computed tomography. Cadaver studies confirmed the presence of potential communications between the retrocrural space and the extrapleural space of the thorax or the posterior pararneal space of the abdomen.

Asunto(s)

RESUMEN

Computed tomography (CT), xeroradiography, and radiography were compared in vitro to assess the relative value of each in detecting soft-tissue foreign bodies. Results indicate that CT may prove useful.

Asunto(s)

RESUMEN

During computed tomography (CT) scanning of the liver, the inferior vena cava can be identified as a separate structure of lesser density adjacent to the caudate lobe in two-thirds of patients without known hepatocellular disease. In patients with alcoholic (portal) cirrhosis of moderate to severe degree, intrahepatic portal veins may not be identified on CT scans, even though their inferior vena cavas can be definitely distinguished from the caudate lobe. Portal cirrhosis causes distortion and obliteration of the portal triads, which is presumably reflected by lack of visualization of intrahepatic portal veins during CT scanning.

Asunto(s)

RESUMEN

Palpable external anatomic landmarks including the xyphoid tip, ends of the eleventh ribs, umbilicus, iliac crests, anterior superior iliac spines, and symphysis pubis were studied in relation to vertebral segments posterior to these landmarks. Results of CT and ultrasound studies, localized according to external abdominal landmarks, can thus be correlated with other radiologic studies in which abnormalities are localized by vertebral level.

Asunto(s)

RESUMEN

The junction of the left renal vein with the inferior vena cava is visualized on most computed tomography studies of the abdomen. This junction is a useful guide in localizing the pancreatic head, just as the superior mesenteric artery is used to localize the body of the pancreas.

Asunto(s)

RESUMEN

Before computed tomography (CT) scanning, a preliminary radiograph of the area of interest is obtained with a Bell-Thompson ruler on the table top parallel to the spine. This allows precise localization of the level of CT sectioning in relation to the vertebral column.

Asunto(s)