Faculty Bibliography

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

The computed tomographic (CT) features of nine documented cases of spinal tuberculosis are analyzed. The mechanisms of vertebral involvement are reviewed. The ability of CT to facilitate the diagnosis as well as to delineate the extent of soft tissue involvement is emphasized. The need for increased alertness to the diagnosis of tuberculosis is stressed.

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

Computed tomography (CT) of the abdomen was performed on 46 patients who had undergone graft replacement of abdominal aortic aneurysms. Twelve postoperative complications were found in nine patients. They included hemorrhage, infection, anastomotic pseudoaneurysms, major vessel occlusion, postoperative pancreatitis, and others. The varied appearance of the normal postoperative graft is also presented. It is concluded that CT is a rapid, sensitive, and noninvasive method for detecting or excluding postoperative complications of abdominal aortic surgery

Thirty patients with lung involvement with Pneumocystis carinii and other opportunistic organisms, many of whom also had Kaposi sarcoma, were seen from December 1980 through March 1982. Clinical manifestations consisted of a prodrome of weeks to months with weight loss, fever, and malaise. When clinical pneumonia became apparent, four distinct radiographic patterns were identified. Pneumocystis carinii was uniformly present, and the most common pattern encountered was a relatively symmetric, homogeneous perihilar pneumonia that progressed to diffuse consolidation. Asymmetric and focal infiltrates were seen in patients who proved to have concomitant opportunistic infection, most commonly fungal in all but two cases. A third pattern of nodular and linear densities with or without adenopathy was seen in patients without pneumonia who had biopsy-positive Kaposi sarcoma involving the lung parenchyma. A fourth pattern represented a combination of any of the first three, and these patients had multiple infections as well as Kaposi sarcoma in the lung. Any significant change in the radiograph indicating progression of disease while on therapy prompted a rebiopsy, and in five of 10 patients other infections and/or Kaposi sarcoma were identified

Computed tomography (CT) was used to evaluate nine patients with bronchial adenomas: five carcinoid tumors and four adenoid-cystic carcinomas. Seven patients with lesions of the trachea or proximal bronchi presented with wheezing, hemoptysis, or obstructive pneumonitis. In such cases CT was effective in displaying the total extent of infiltrating lesions including the extraluminal component. The cases of adenoid-cystic carcinoma of the bronchi demonstrated extraluminal spread in a pattern indistinguishable from bronchogenic carcinoma. In one patient, CT demonstrated an exclusively endobronchial carcinoid tumor, and conservative resection was planned and accomplished. In two cases of carcinoid tumors that presented as solitary pulmonary nodules adjacent to bronchi in the midlung zone, CT served as a road map for the bronchoscopist. Computed tomography has been employed in the post-operative patient to evaluate for possible recurrence.

Computed tomography (CT) was performed on six patients with bronchiectasis. In two cases of advanced cystic bronchiectasis, the diagnosis was apparent on plain chest roentgenograms. In four cases, bronciectasis was initially diagnosed by CT and later confirmed by bronchography. The CT signs of bronchiectasis include air--fluid levels in distended bronchi, a linear array or cluster of cysts, dilated bronchi in the periphery of the lung, and bronchial wall thickening due to peribronchial fibrosis. Distended bronchi must be distinguished from emphysematous blebs, which generally have no definable wall thickness and no accompanying vessels. It is concluded that CT should have a role in establishing the presence and anatomic extent of bronchiectasis.

Computed tomography can be used to evaluate abnormal pulmonary hila. A series of cases is presented that illustrate the appearance of dilated pulmonary arteries, absent pulmonary artery, hilar adenopathy, and hilar masses.

This report presents a detailed analysis of normal cross-sectional hilar anatomy. Specially prepared cadavers injected with red and blue latex were utilized for correlation with 100 normal computed tomographic examinations. Thorough knowledge of the normal appearance of cross-sectional hilar anatomy is a prerequisite for recognizing abnormalities that affect the pulmonary hila.

Computed tomography (CT) can be used to diagnose both inflammatory and neoplastic diseases that arise from or affect the bronchi. The clarity of anatomic detail that can be obtained with CT is demonstrated. This clarity of anatomic detail should be of use in those cases for which bronchoscopy, mediastinoscopy, or other staging procedures are planned. The overall usefulness of CT in patients with bronchial lesions has yet to be established.