Computed tomography of complicated cholecystitis

Reported are 10 patients with surgically verified acute cholecystitis and its complications. Of these 10 patients, 6 (60%) had atypical clinical presentation so that cholecystitis was not the primary diagnosis being considered before computed tomography. Common computed tomography findings included gallbladder wall thickening (100%), pericholecystic fluid (80%), gallstones (50%), and air in the gallbladder lumen and wall (20%). An awareness of the computed tomography appearances can be helpful in the diagnosis of complicated cholecystitis even when the clinical presentation is atypical.

Computed tomography of vaginitis emphysematosa

Vaginitis emphysematosa is characterized by multiple gas-filled spaces in the vagina and exocervix. Although the diagnosis can be made on physical examination and on plain radiography, it is important to recognize its appearance on CT since it may constitute a serendipitous finding that should be differentiated from more serious diseases that have a similar appearance.

Retroaortic left renal vein: an interpretive pitfall on computed tomography

In a patient with retroaortic left renal vein, the anomalous vessel is demonstrated by computed tomography to take a caudal course of several centimeters before crossing in a retroaortic fashion to join with the inferior vena cava. This case differs from previously published reports. Computed tomography provided excellent anatomic details of the vascular anomaly and highlighted the value of postcontrast dynamic computed tomography scanning.

Computed tomography demonstration of traumatic suburothelial hemorrhage

We report a patient with the characteristic findings of suburothelial hemorrhage secondary to blunt trauma that was initially detected by computed tomography.

Computed tomography of the kidney

The development and refinement of computed tomography have revolutionized the diagnostic evaluation of patients in urologic practice. This article reviews the applications and interpretation, as well as the limitations, of renal computed tomography and compares this modality with other imaging studies of the kidney.

CT diagnosis of fluid in lesser sac mimicking thrombosis of inferior vena cava

A patient with ascites and fluid in the lesser sac mimicking the appearance of a clot in the inferior vena cava is described. A knowledge of liver anatomy, particularly the lesser sac in the region of porta hepatis, aids in avoiding this CT pitfall.

Computed tomography detection of transplant renal artery pseudoaneurysm

Clinically unsuspected pseudoaneurysm formation of the arterial anastomosis in a patient with a renal transplant was initially diagnosed by computed tomography. This rare but serious complication can also be detected by ultrasound or radionuclide flow study, as shown in our patient. An awareness of this lesion and familiarity with its appearance can permit its early detection before exsanguinating hemorrhage occurs.

Artifact-free computed tomography of the chest and abdomen in the severely ill patient

A method is described for obtaining consistently high-quality images during nonneurologic computed tomography of the severely ill and uncooperative patient using a neuromuscular blocker to induce apnea. Careful control of respiration during data acquisition eliminates motion artifacts.

A pseudomass on pelvic computed tomography: a pitfall to avoid

Reported here is a patient with celiac disease in whom a spurious pelvic mass was suggested by computed tomography. This pitfall can be prevented by an awareness of the normal appearance of the small bowel following intravenous contrast enhancement and by monitoring of the examination by a radiologist. Delayed scanning or real-time ultrasound examination will confirm that the initial computed tomography appearance is due to small bowel loops.

Computed tomographic diagnosis of hepatic metastases in fatty infiltration

A patient with carcinoma of head of pancreas is described. The density of liver metastases on computed tomography was much higher than the density of the surrounding liver parenchyma due to the fatty infiltration of liver.

Computed tomography in detection of occult hypernephroma

Five cases in which computed tomography (CT) detected a hypernephroma that had been missed by one or more of the other imaging modalities are reported here. Computed tomography may have an important role in the diagnosis of radiologically occult hypernephroma.

An unusual presentation of mediastinal Hodgkin's lymphoma on computed tomography

Untreated mediastinal Hodgkin's lymphoma may present with calcification within the tumor mass. Therefore, Hodgkin's lymphoma should be included among the possible diagnoses of calcification in an anterior mediastinal mass, as visible on chest CT or mediastinal tomography.

Radiologic investigation of suspected extrahepatic biliary obstruction

Data for 94 patients clinically suspected of having extrahepatic biliary obstruction who were referred for radiologic investigations were studied to compare the value of various imaging modalities used to detect this condition. Computed tomography emerged as the best indirect, noninvasive technique and percutaneous transhepatic cholangiography as the best direct technique. A standard approach to investigating suspected extrahepatic biliary obstruction is suggested that takes into consideration the interventional radiologic techniques currently used to treat this condition.

Endoscopic papillotomy

Endoscopic papillotomy is a major therapeutic advance in the management of common bile duct obstruction. During 1981, the procedure was performed in 48 of 51 patients between 17 and 93 years of age. There were 13 men and 35 women. Common duct stones were removed in 26 of 31 patients (84%), six of whom had their gallbladders in place and two of whom had cholangitis. Failure in five patients occurred because of stone adherence to the common duct wall, stone size, ductal stenosis, or caught Dormia basket. Papillotomy was done in 10 of 11 patients for stenosis, two for recurrent pancreatitis, two with the sump syndrome, one for hemobilia, and one for bile duct tumor biopsy. The "precut" technique was required in 11 patients. Mild pancreatitis developed in three patients and severe hemorrhagic pancreatitis in one. Three of the four had the precut technique. One patient had minor bleeding, and two developed acute cholangitis requiring laparotomy, one of whom died (2.1%) 40 days after initial endoscopic papillotomy. A Dormia basket became caught in one patient. The duration of hospitalization was 24 to 36 hours after endoscopic papillotomy. Endoscopic papillotomy is considered the method of choice in the management of postcholecystectomy choledocholithiasis.

The role of computed tomography in abdominal and pelvic trauma

CT findings in 32 patients with abdominal and pelvic trauma are the subject of this report. Four patients had more than one organ involved. The most common abdominal organ to be injured in our series was the pancreas, unlike other series. Findings of pancreatic, splenic, hepatic, renal, and pelvic injuries are described. The role of CT in the investigation of a patient with abdominal and pelvic trauma is discussed and compared with other imaging modalities. CT was found to be superior especially as it is highly sensitive and not organ specific.

Sagittal and coronal reconstruction in body CT

A review of 15 months' experience shows the major indications for sagittal and coronal reconstruction images in computed body tomography (CBT) are in the differentiation of lung disease from disease of the chest wall; of supradiaphragmatic from infradiaphragmatic lesions; of intrahepatic from perihepatic abnormality; of renal from perirenal disease; in establishing the level of obstruction in the jaundiced patient and in mapping pelvic malignancy. The accurate definition of the extent of disease proved beneficial in planning further diagnostic procedures (needle aspiration for malignant cells or abscess drainage), in determining the surgical approach, and in planning radiation therapy.

Primary Chylopericardium: combined lymphangiographic and CT diagnosis

A case of primary chylopericardium is reported, and the usefulness of combined computed tomography and lymphangiography diagnosis of lymphatic leakage is demonstrated.