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We report the case of a 67-year-old woman who presented with an apparent bladder tumor and complaints of increased urinary frequency and postvoiding pain. Her diagnostic work-up revealed conflicting findings regarding the source of her bladder disease, and laparoscopy was required to make the final diagnosis of appendicitis. The presentation of appendicitis can be disguised and is often a difficult diagnosis.

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The treatment of benign and malignant oropharyngeal diseases is greatly influenced by the degree of invasion of the mandible and maxilla. 3D DEN (Columbia Scientific, Inc., Columbia, MD) is a computer software program that reassembles data from a series of axial CT scans into cross-sectional oblique, three-dimensional, and panoramic CT reformations. Multiplanar reformatted CT overcomes many of the problems associated with conventional axial and coronal CT. True cross-sectional and panoramic images are obtained. The contour, height, thickness, and mineralization of the entire alveolar bone along the curvature of the jaw are precisely defined. Also, the course of the inferior alveolar nerve, anatomic features of the incisive canal, and evaluation of the maxillary sinus can be assessed with this technique. This technique was originally developed to evaluate dental implants [1-3]. Other software programs are commercially available that do similar reconstructions. The purpose of this pictorial essay is to illustrate the findings on multiplanar reformatted and three-dimensional CT in the preoperative evaluation of mandibular and maxillary abnormalities.

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We studied a new method of obtaining diagnostic cytology samples from the liver that differs from fine-needle aspiration cytology in that no suction is used to obtain the sample. This method is simpler to perform than traditional aspiration biopsy and yields concentrated cell smears that are easier to interpret. The sample enters the needle because of capillary action, a physical property of fluid that causes it to flow into the lumen of a narrow channel. This nonaspiration technique was used in 40 consecutive patients undergoing fine-needle biopsy of mass lesions of the liver. A 22-gauge spinal needle was used in all procedures. The cytology smears obtained were prepared, stained, and interpreted by the same methods used for conventional fine-needle cytology specimens. Specific diagnoses were rendered in 36 patients (90%) and in 32 (94%) of those patients with malignant tumors. An average of 1.7 needle passes (range, 1-4) was needed per patient. We conclude that the results from nonaspiration fine-needle cytology of the liver are as good as those from conventional aspiration technique, and the nonaspiration technique is easier to perform and results in smears that are easier to interpret.

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The advantages of tube versus bifurcation graft replacement of abdominal aortic aneurysms are well known, yet the risk of future development of iliac occlusive or aneurysmal disease still leads many to use bifurcation grafts routinely. Several studies have reported little risk of this development when patients are followed clinically. They suffer, however, from lack of an objective means of identifying iliac aneurysms. Among 83 patients undergoing abdominal aortic aneurysmectomy during a 53 month period, 36 who had received a tube graft were available for follow-up. After a mean of 54 months from the time of surgery, these patients were evaluated by abdominal and pelvic computed tomography to determine the incidence of subsequent iliac aneurysm formation. No patient had developed symptoms or signs of iliac occlusive disease during this interval. In addition, no residual aortic aneurysms or new iliac aneurysms were noted. In the absence of iliac occlusive or aneurysmal disease, straight graft replacement is the preferred therapy for abdominal aortic aneurysms. The risk of future development of these lesions is minimal.

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Unusual manifestations of common diseases are still relatively common events. Crohn's disease may involve the entire gastrointestinal tract from the pharynx to the anus. Although the classic findings of ileocolic disease are well known, the changes described above are less commonly encountered. They may be subject to misdiagnosis unless the protean manifestations of Crohn's disease are kept in mind.

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Of 276 patients undergoing CT using a power injector to deliver contrast material, 71 (26%) demonstrated a pseudothrombus in the suprarenal inferior vena cava. This occurs much more commonly than in patients injected by hand and is a potential pitfall in interpreting these scans.

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The initial diagnosis for three adult patients with giant choledochal cysts was confused because of the enormous size of the cysts. Jaundice in association with marked upper gastrointestinal displacement was the dominant feature in two of our cases. Intrahepatic ductal dilatation is common when choledochal cysts present in the adult. The malignant potential of choledochal cysts is discussed.

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We report a metastatic nonfunctioning islet cell carcinoma of the head of the pancreas associated with complete fatty replacement of the pancreatic body and tail. This mass was only appreciated because of the contrast offered by the adjacent fat-replaced pancreatic body and tail.

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We report a patient with delayed development of a splenic subcapsular hematoma following abdominal trauma. This unique occurrence may well explain the more commonly known phenomenon of delayed rupture of the spleen after trauma.

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Anomalies of the inferior vena cava, azygous venous system and renal veins may take many forms. We report a patient with azygous continuation of a left-sided inferior vena cava with an associated retroaortic right renal vein. To our knowledge, this is the first such report.

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The diagnosis of fecaloma can occasionally be difficult. A case is presented in which computed tomography was valuable in making the diagnosis.

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A single case of hernia of Morgagni diagnosed by computed tomography (CT) is presented. CT is an accurate, noninvasive method of evaluating this entity and can replace many of the other imaging modalities previously employed.

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Endobronchial lipomas are rare, benign neoplasms that are not often diagnosed prior to surgical or bronchoscopic resection. Computed tomography can provide a powerful adjunct to conventional modalities in determining the nature of an endobronchial lesion and may prevent unnecessary surgery.

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Three cases of spinal epidural hematoma are presented. Computed tomography (CT) was the first diagnostic method used in two patients and demonstrated a surgically confirmed spinal epidural hematoma in both patients. In a third patient who presented with a complete block on myelography, CT was helpful in assessment of the extent of the lesion and suggested a vertebral hemangioma as the cause of the hematoma. CT is a very useful tool in the diagnosis of spinal epidural hematomas.

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The computed tomographic (CT) appearance of an esophageal duplication cyst is reported. The value of CT in evaluating the extent of the lesion and ruling out other associated anomalies is discussed.

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