Faculty Bibliography

A ureteroinguinal hernia was demonstrated on both a Tc-99m mercaptoacetyltriglycine (MAG3) renal scan and a computed tomographic scan in an 81-year-old man with suspected urinary tract infection and a prior history of transurethral resection of the prostate. Ureteral hernias are relatively rare, although the ureteroinguinal hernia, found in elderly men on the right side, is the most common type. Ureteral hernias may be asymptomatic but can be present in patients with symptoms of obstructive uropathy.

We report the radiology and pathology of a patient with xanthogranulomatous cholecystitis (XC) and review the literature on this unusual condition.

There have been few reports of the CT findings of intestinal lymphangiectasia in adults, and no CT descriptions have been reported in the literature in children. We describe the CT appearance of a biopsy-proven case of primary small intestinal lymphangiectasia in a 3-year-old boy, and we will review the limited literature on the CT findings in this disorder in adults.

OBJECTIVE:The purpose of this study was to evaluate the clinical significance of the "flat cava" sign on abdominal CT scans in hospitalized patients without trauma. MATERIALS AND METHODS/METHODS:CT scans of the abdomen of 500 inpatients imaged for a wide variety of nontraumatic indications were retrospectively reviewed for a flat cava sign. Two radiologists measured the maximal anteroposterior and transverse diameters of the inferior vena cava at four predetermined levels. The medical records of the subset of patients with a flat cava sign--defined as a maximal transverse-to-anteroposterior ratio of 3:1 or greater at one or more of the four levels--were reviewed for evidence of hypovolemia or hypotension. RESULTS:Seventy patients (14%; 48 women, 22 men) had a flat inferior vena cava present on at least one of the four levels. Of these 70 patients, 21 had definite and three had possible clinical evidence of hypotension or hypovolemia. A flat cava sign isolated to only one level was seen in 22 of the 70 patients, most commonly at the level just below the renal veins, and only four of these 22 patients had evidence of hypotension or hypovolemia. CONCLUSION/CONCLUSIONS:Of the 500 inpatients, 14% had a flat cava sign on at least one of the four levels examined on abdominal CT scans. The majority of these patients with a flat cava sign did not have hypotension or evidence of hypovolemia, but a minority (30%) did.

Jackstone calculi are urinary tract stones that have a specific appearance resembling toy jacks. They are almost always composed of calcium oxalate dihydrate and may be found in the urinary bladder or rarely in the upper urinary tract. Their appearance on plain radiographs and computed tomography (CT) in human patients has been well described. They have also been imaged in several species of animals. However, our review of the English medical literature revealed no previous report in which a jackstone calculus had been identified on the sonographic examination of a human patient. We report a case in which a large jackstone calculus was incidentally detected during abdominal sonography in a 75-year-old man.

The combination of computed tomographic (CT) venography and pulmonary angiography (CTVPA) was initially described in 1998 as a single comprehensive noninvasive imaging examination for suspected thromboembolic disease. It allowed the identification of pulmonary embolism as well as deep venous thrombosis (DVT) in the abdomen, pelvis, thighs, and calves. The venographic portion of CTVPA has now been studied by multiple researchers and has been shown to be an accurate imaging study for the thigh veins in comparison with lower extremity sonography. In contrast to sonography, however, CTVPA readily and rapidly permits evaluation of the inferior vena cava, the pelvic veins, the calf veins, and all of the superficial venous system. Complex venous anatomy can be surveyed, an additional sonographic study is not required, and only a few extra minutes and images are required over and above CT pulmonary angiography. A review of 957 recent cases of suspected pulmonary embolism examined with CTVPA revealed an overall 10.5% frequency of DVT, with a nearly equal distribution of thrombosis at the common femoral, superficial femoral, popliteal, and deep calf veins. Although a variety of protocols for CTVPA may be implemented, including a contiguous helical acquisition, obtaining 5- or 10-mm-thick images every 4 cm provides a high degree of accuracy and decreases overall radiation dose.

Forty outpatients were randomized into two groups of 20. Twenty patients received 1 mg of intravenous glucagon and the other 20 did not. Three radiologists evaluated the bowel using a qualitative score and mean scores for each bowel level were compared. A different radiologist measured the maximal diameter of bowel at seven levels. There were no significant differences in qualitative or quantitative data for the two groups. Intravenous glucagon is therefore not routinely recommended for helical CT of the abdomen.