Faculty Bibliography

Computed tomography has been found to be a useful tool in the evaluation of cardiac masses. It can be most effacious in the detection of a lesion and in the delineation of its size and location, as well as the demonstration of its relationships to intra- and extracardiac structures. It can be especially useful in areas of the heart where echocardiography can be difficult. This is particularly true for the left atrium, where lesions such as small thrombi can be missed.

Thirty-eight consecutive patients admitted to the hospital with pelvic and acetabular fractures underwent CT examination. The axial plane of CT is shown to be the most suitable for evaluation of these fractures. The fracture pattern is readily demonstrated, facilitating fracture classification. The degree of fracture fragment displacement and rotation, hip joint stability, and intra-articular osseous fragments can be determined. A number of unsuspected fractures were detected, including five sacral and four anterior acetabular wall fractures; the latter were due to extension of superior ramus fractures. Soft tissue injuries included several hematomas, serosanguinous cysts in one patient, and bladder laceration in one patient. It is concluded that in patients with pelvic fracture CT examination is the method of choice following preliminary radiographic evaluation, if further radiographic investigation is deemed necessary

Forty-nine patients with chest wall lesions were evaluated by computed tomography (CT) and conventional radiography. Computed tomography was found to be indispensable for detecting and precisely localizing these lesions. It revealed unsuspected bone destruction and lung, pleural, and mediastinal involvement, as well as invasion of the spinal canal. In more than two thirds of the patients, CT provided additional information of clinical importance in management and, in one third, treatment was altered or the surgical approach modified because of the CT findings. Computed tomography is an essential diagnostic modality in evaluating chest wall lesions

From 275 computed tomographic (CT) examinations with positive findings of abdominal lymphoma, 26 patients were found to have gastrointestinal involvement by the disease. The stomach was most commonly involved, followed by small bowel, colon, and duodenum. CT was found to be accurate in detecting wall thickening and complications such as perforation and fistulization. False-negative examinations occurred in two patients with small submucosal gastric deposits ('bull's-eye' lesions). False-positive examinations were seen in two patients with hypertrophic gastritis. The CT manifestations of gastrointestinal lymphoma, correlated with the barium study appearance, are the subject of this report

Eighteen patients with unilateral non-metastatic, non-functioning adrenal masses were studied with computed tomography (CT). Pathological examination in 6 cases revealed benign adrenal adenoma. The others were followed up with serial CT scans and found to show no change in tumor size over a period of six months to three years. On the basis of these findings, the authors suggest certain criteria of a benign adrenal mass, including (a) diameter less than 5 cm, (b) smooth contour, (c) well-defined margin, and (d) no change in size on follow-up. Serial CT scanning can be used as an alternative to surgery in the management of many of these patients

Fifty-eight consecutive cases of peridiaphragmatic fluid collections were correctly localized by computed tomography. The key to accurate localization of peridiaphragmatic fluid is identification of the hemidiaphragms. Pulmonary consolidation and pleural fluid collections lie adjacent and peripheral to the convexity of the hemidiaphragms. Free pleural fluid distends the posterior pleural recesses, important anatomic landmarks beneath the bases of the lungs. Intra-abdominal fluid collections lie adjacent and central to the convexity of the hemidiaphragms. On the right side intraperitoneal fluid is restricted from contact with the bare area of the liver by the coronary ligaments. It is concluded that peridiaphragmatic fluid collections can generally be readily identified if one is familiar with normal cross-sectional anatomy

Computed tomographic examinations in 75 normal individuals are analyzed to define the cross-sectional anatomy of the diaphragm. Anatomic relationships among the inferoposterior portions of the lungs, the pleura, and the hemidiaphragms are clarified. The posterior pleural recess, an important potential space, is described and illustrated. The relationships of the crura, arcuate ligaments, and the hemidiaphragms are discussed as well. Awareness of these anatomic relationships forms an important basis in analyzing peridiaphragmatic fluid collections

A retrospective review of 96 abdominal abscesses yielded 11 cases (9%) that were diffusely echogenic on sonograms and that stimulated findings of solid lesions. Sonographic features of these abscesses were analyzed and compared with features of 78 cases of hepatic metastasis. An abscess was considered solid appearing when it contained diffuse internal echoes that were distributed over 90% of the abscess cavity. The visualized internal echoes were of low to medium amplitude, and were generally similar to the normal echogenicity of the parenchymal organs, such as the liver, spleen, or uterus. Distal acoustic enhancement was seen in 91% of the solid abscesses, and it was not seen in hepatic metastases. A distinct echogenic wall was present in 64% of the abscesses (subacute and chronic lesions), but this occurred in less than 4% of metastases. Thin peripheral halos inside or outside of and adjacent to the abscess wall were seen in 36% of abscesses. The peripheral halos seen in metastases were wider and not associated with an echogenic wall. The diagnosis of a diffusely echogenic abscess and differentiation from a neoplasm is possible when the sonographic findings of acoustic enhancement, thin peripheral halo, and echogenic abscess wall are present

Communication between a hydatid cyst of the liver and the right hepatic duct resulted in biliary obstruction by the released cyst contents. Ultrasonography and computed tomography were utilized for preoperative diagnosis