Faculty Bibliography

The CT and clinical findings are presented in seven patients with diffuse peritoneal malignancy caused by non-Hodgkin lymphoma. All seven patients had CT evidence of ascites, omental infiltration, and peritoneal implants mimicking carcinomatosis. Bulky retroperitoneal or mesenteric adenopathy was present in only one patient. Four of the seven patients had documented AIDS. Paracentesis provided a diagnosis of lymphoma in only one of the seven patients. In the other six patients, the final diagnosis was established by surgery (three patients), by autopsy (one patient), by laparoscopy (one patient), and by guided needle aspiration (one patient). Although uncommon, lymphoma should be considered in patients who have diffuse peritoneal malignancy, particularly those who are at risk for AIDS

Colonic adenocarcinoma developed in an intravenous drug abuser with the acquired immune deficiency syndrome (AIDS) that was diagnosed by the presence of antibodies to the human immunodeficiency virus (HIV), generalized lymphadenopathy, and biopsy proven esophageal candidiasis. The colon cancer presented atypically at a young age with no known risk factors and with a bulky primary tumor and a local fistula. AIDS and AIDS risk factors have been associated with Kaposi's sarcoma, lymphomas, and anal and oropharyngeal carcinoma. This report suggests a possible association between colonic adenocarcinoma and AIDS

The anatomy and pathology of the greater omentum as demonstrated by CT has been well described. Approximately 80% of cases of omental pathology are caused by malignancy and the remaining 20% are the result of inflammatory disease, mainly tuberculosis or pancreatitis. Histoplasmosis has not been previously reported to involve the greater omentum. We report a case of disseminated histoplasmosis that presented with infiltration of the greater omentum and the small bowel mesentery in a patient with acquired immuno-deficiency syndrome

Two cases of pancreatic ascites are presented in which preoperative endoscopic retrograde pancreatography (ERP) precisely identified the exact location of the leakage of pancreatic juice into the peritoneal cavity. Computed tomography was not helpful in either case. Endoscopic retrograde pancreatography is the most valuable imaging examination to confirm the diagnosis of pancreatic ascites and to direct surgical management

Cytomegalovirus is one of the more common opportunistic organisms implicated in the development of esophagitis in patients with AIDS. A review of the radiographic features of 16 proved cases of cytomegalovirus esophagitis showed a spectrum of abnormalities related to the severity of the inflammatory process. Seven patients had a mild form of esophagitis with segmental involvement characterized by granular mucosa, superficial erosions, and poorly defined, shallow ulcerations. Nine patients had more severe esophagitis with solitary or multiple deep ulcers and a background of normal mucosa. The deep ulcerations were oval in shape and varied in size. Some projected intraluminally and had a thin rim of radiolucency at the base. Short-term follow-up examinations showed progression of the disease in four patients, no change in one patient, and regression without specific therapy in one patient. Although these radiographic features are highly suggestive of cytomegalovirus esophagitis, the diagnosis requires histologic confirmation

Fine transverse folds of the esophagus are well described as a transient motor phenomenon seen in patients with or without gastroesophageal reflux. They appear to be due to contraction of the muscularis mucosa and are thought to have little, if any, significance. We have observed similar transverse folds in the gastric antrum during double-contrast upper gastrointestinal series in five patients. In contrast to the transient nature of the folds in the esophagus, these gastric folds were more persistent. They were seen in multiple spot images with the gastric antrum distended or partially collapsed and even during peristalsis. In follow-up studies, the folds were repeatedly demonstrated in two patients. Two patients had associated gastric polyps with histologic evidence of chronic gastritis; however, the antral mucosa appeared normal on endoscopy. The remaining three patients had no associated gastric disease. The pathophysiologic significance of these folds is yet to be determined; however, they appear to be clinically insignificant

A case of small intestinal amyloidosis that has a myriad punctate mucosal relief pattern of minute filling defects and barium flecks is presented with pathological correlation. Amyloidosis is added to the differential diagnosis of this radiographic small bowel appearance