Faculty Bibliography

PURPOSE: We report the results of a multicenter study of arterial, corticomedullary, nephrographic and excretory phase helical computerized tomography (CT) for detecting and characterizing abnormalities causing asymptomatic microscopic hematuria. MATERIALS AND METHODS: We evaluated 350 consecutive patients, including 216 men and 134 women 23 to 88 years old, with asymptomatic microscopic hematuria of undetermined cause at 4 medical centers. Patients with known urological pathology were excluded from study. We performed 4 helical CT sequences, including pre-enhancement phase imaging from kidney to symphysis pubis, arterial phase imaging of the kidney and lower pelvis, corticomedullary nephrographic phase imaging of the kidney and lower pelvis, and excretory phase imaging from kidney to symphysis pubis with 2 to 5 mm. collimation and 1 to 1.5 pitch. RESULTS: Of 171 proved lesions 158 were correctly diagnosed. There were 10 false-positive and 13 false-negative diagnoses, indicating 0.9239 sensitivity, 0.9441 specificity, 0.9404 positive and 0.9285 negative predictive values, (p <0.001). All cases of congenital renal lesions, calculous disease, ureteral lesion and neoplastic lesion of the bladder were correctly diagnosed, as were 40 of 41 inflammatory renal, 21 of 23 renal masses and 13 of 16 inflammatory bladder lesions. In 27 patients with renal calculi the study was limited to pre-enhancement spiral CT. CONCLUSIONS: A positive diagnosis rate of 45.1% (158 of 350 cases) for the causes of heretofore refractory cases of hematuria with high sensitivity and specificity attest to the effectiveness of our hematuria CT protocol and support its use

We present a case of coarctation of the aorta with a post-stenotic aneurysm in a 79-year-old male patient. Diagnostic studies included computed tomographic angiogram, magnetic resonance angiogram and digital subtraction angiogram. Our patient underwent operative therapy that resulted in improvement of his hypertension and cardiac function

We report two cases of portal vein visualization during ERCP in patients with pancreatitis, one from inadvertent cannulation of the superior mesenteric vein, and in the other, through a preexisting fistula. Prompt recognition of this potentially significant event will obviate confusion and unnecessary prolongation of the procedure

PURPOSE: To describe the diaphragm muscle slip sign, a previously unreported finding of pneumoperitoneum on plain radiographs. MATERIALS AND METHODS: Diaphragmatic muscle slips were observed on supine plain abdominal (n = 6) or recumbent frontal chest (n = 3) radiographs in nine patients. Computed tomographic (CT) confirmation was available in six patients; free air was depicted on upright chest radiographs in the other three patients. RESULTS: Muscle slips of the costal portion of the diaphragm were depicted in the right upper quadrant as they indented the adjacent air-filled peritoneal cavity. On supine radiographs, these discrete muscle bundles appeared as two or three large, arcuate interfaces or as bands of increased opacity of similar dimensions, with their long axes directed vertically. These smoothly marginated bundles were parallel to the dome and converged superomedially. On the CT scans, the costal muscle slips were clearly defined as bands or small peripheral triangles impinging on the parietal peritoneum. CONCLUSION: Depiction of the undersurface of the long costal muscle slips of the diaphragm on supine plain radiographs is a sign of pneumoperitoneum

PURPOSE: To assess visualization of the extrahepatic segment of the ligamentum teres on plain radiographs, the ligamentum teres sign, which is an indicator of pneumoperitoneum. MATERIALS AND METHODS: The ligamentum teres was recognized in 12 patients with pneumoperitoneum. Findings from supine radiographs were correlated with those from oblique radiographs and computed tomograms. RESULTS: The extrahepatic segment of the ligamentum teres, which extended between the umbilicus and the ligamentum teres notch at the inferior border of the liver, was visualized on supine radiographs. The ligamentum teres appeared in the right upper quadrant as an obliquely oriented, straight, or slightly arcuate interface with a sharply demarcated inferolateral margin or as a similarly positioned, well-defined band of soft tissue of varying length. The falciform ligament was also seen in six of the 12 patients as a long, thin line that ran vertically to the right of the midline and joined the ligamentum teres caudally near or at the umbilicus. Even though there were other signs of pneumoperitoneum in all cases, the ligamentum teres sign was the most prominent in three cases. CONCLUSION: Visualization of the extrahepatic segment of the ligamentum teres on supine radiographs requires the anterior accumulation of extraluminal, intraperifoneal gas and is another sign of moderate to massive amounts of free air