Passive hepatic congestion: cross-sectional imaging features

Passive hepatic congestion is caused by stasis of blood within the liver parenchyma due to compromise of hepatic venous drainage. It is a common complication of congestive heart failure and constrictive pericarditis, wherein elevated central venous pressure is directly transmitted from the right atrium to the hepatic veins because of their close anatomic relationship (Fig. 1). The liver becomes tensely swollen as the hepatic sinusoids dilate and engorge to accommodate the backflow of blood. A variety of structural and functional hepatic derangements develop that have distinctive appearances on sonograms, CT scans, and MR images.

CT of rhabdomyolysis associated with malignant hyperthermia and seizures

Computed tomography evaluation in rhabdomyolysis can reveal muscle necrosis and calcification. We report the computed tomography findings in acute rhabdomyolysis, secondary to hyperthermia and seizures.

Extragonadal seminoma involving urinary bladder and arising in the prostate

The authors report the first instance of a patient with seminoma probably arising from the prostate but also involving the bladder. A 58-year-old man presented with symptoms and signs of prostatic enlargement. Cystoscopy revealed a fungating neoplasm, probably arising from the prostate and surrounding the bladder neck. The biopsy was consistent with the diagnosis of seminoma. The patient experienced complete remission after chemotherapy with bleomycin, cisplatin, and etoposide.

Renal failure due to bronchogenic adenocarcinoma metastatic to kidneys

A case is presented of a fifty-eight-year-old woman with bronchogenic adenocarcinoma in whom renal failure developed manifested by hypertension and azotemia. Subsequent percutaneous needle aspiration biopsy confirmed metastatic renal involvement. No etiology other than renal infiltration due to metastatic bronchogenic adenocarcinoma was found to explain the renal failure. Literature review revealed no previous reported case of metastatic bronchogenic adenocarcinoma to the kidney presenting antemortem with renal failure.

Non-Hodgkin lymphoma of ureteral wall: CT findings

We report a case of focal ureteral wall non-Hodgkin lymphoma without contiguous or other associated abdominal abnormalities. The CT findings and the differential diagnosis are discussed.

Ectopic pregnancy: surgical-pathologic correlation with US

The ultrasound (US) examinations of 53 patients with proved ectopic pregnancy were reviewed and compared with surgical and pathologic findings. The most common finding with US and surgery was free fluid. Hematosalpinx tended to have sharply defined margins, whereas free pelvic hematomas were poorly defined or filled the pelvis. The echogenicity of the clots was variable but generally in the same range of echogenicity as the uterus. A prominent decidual reaction occurred in 26% of the patients and had a variety of appearances.

CT diagnosis of occult incisional hernias

CT of the abdomen was performed on 14 adult patients 2-25 months after laparotomy in order to evaluate intraabdominal processes. Clinically unsuspected incisional hernias were detected in all cases. These herniations were not disclosed by previous physical examination because of the patients' obesity, abdominal pain, distension, or various other factors. However, CT scans showed the exact size, location, and content of each incisional hernia. The evaluation of postsurgical abdomen by CT should include a careful assessment of previous laparotomy sites in search of occult incisional hernias that may be the source of the patient's abdominal symptoms.

Sonographic demonstration of renal arterial calcification simulating multiple renal calculi

A case of arterial calcification simulating renal calculi during ultrasound examination is described. The differential diagnosis of echogenic foci with acoustic shadowing is discussed.

Burkitt's lymphoma of the stomach

An unusual case of American Burkitt's lymphoma originating in the stomach of an elderly man is presented. Computed tomography revealed diffuse infiltration of the gastric wall by a solid tumor measuring 2.5 to 5.5 cm in thickness. Despite such bulky tumor, however, distensibility of the stomach was preserved because Burkitt's lymphoma does not induce desmoplastic reaction and linitis plastica.

Accessory hemiazygos continuation of left inferior vena cava: CT demonstration

The first CT description of accessory hemiazygos continuation of a left-sided inferior vena cava is presented. This venous anomaly appears as a mediastinal mass on plain chest films and may simulate an aortic dissection on CT or angiography. Careful attention to the various abnormal vascular pathways will obviate the need for further invasive testing.

Sonography of ovarian tumors: predictability of tumor type

One hundred six ovarian neoplasms were evaluated with respect to size, echogenic characteristics, and percentage of echogenic material to determine if sonography could differentiate between malignant and benign tumors and if histology could be determined. This study indicates that anechoic lesions have high likelihood of being benign tumors, usually mucinous cystadenomas or serous cystadenomas. As the percentage of echogenic material increases, the likelihood of malignancy also increases. There are two exceptions to this rule. The first is lesions with very echogenic foci, which are virtually always benign teratomas. The second is groups of tumors that are totally or near-totally echogenic. These are actually less likely to be malignancies than mixed-density tumors that have a large anechoic component. In mixed-echogenicity tumors that are not teratomas, there was no way of distinguishing between benign and malignant lesions with an acceptable degree of accuracy in an individual case. Also, with the exception of teratomas, histology could not be determined. It should be noted that in the postmenopausal patient, the maximum size of a normal ovary is 2 X 1.5 X 0.5 cm. An adnexal mass larger than this must be considered suspicious of a neoplasm.

Computed tomography appearance of fused (horseshoe) kidney

Horseshoe kidneys occur approximately once in every 400-500 births. We present three cases of renal fusion anomalies with their computed tomography scans. In patients with little retroperitoneal fat the presence of a renal fusion anomaly can mimic a retroperitoneal mass. Horseshoe kidneys can be suspected by the characteristic anteromedial placement of the renal hilar structures and by enhancement after contrast infusion. An intravenous pyelogram will confirm the finding.

Extensive abdominal lymphadenopathy in sarcoidosis

A case of sarcoidosis with minimal pulmonary findings and extensive abdominal lymphadenopathy is presented. As radiologists continue to examine the abdomen with the newer diagnostic modalities of computed tomography and ultrasound, they may find that abdominal nodal involvement in sarcoidosis is more common than currently recognized.

Texture patterns in pancreatic sonograms

In a retrospective study of 163 pancreatic sonograms, five internal echo patterns were correlated with the ultimate clinical diagnoses. Attention to the internal echo patterns of the pancreas can provide useful information in diagnosing pancreatic disease, including identification of abnormalities in glands of normal size and contour.

Circumscribed eosinophilic gastroenteritis

A case of eosinophilic gastroenteritis with peripheral blood eosinophilia and typical histology is described. The location, radiographic appearance, and gross pathologic appearance of the lesion were unique in that they resembled eosinophilic granuloma of the stomach. Also unique was the fact that the distal esophagus as well as the stomach was involved. This case demonstrates that eosinophilic gastroenteritis may involve any portion of the gastrointestinal tract and that the radiologic distinction between eosinophilic gastroenteritis and eosinophilic granuloma may not be as clear cut as previously thought.

Accuracy of placental localization by ultrasound

In a retrospective study, ultrasound diagnoses were correct in 93% of 164 patients referred for examination because of suspected placenta praevia. There was one false-negative finding in 13 cases of proven placenta praevia, and ten false-positive errors in 151 true-negative cases. False-positive results represented the largest number of errors. Examination of the patient with an empty bladder, in addition to the routine technique, is suggested to reduce the number of false-positive results.

Ultrasound in the staging of lymphoma

Ultrasonography of the abdomen and pelvis was performed in 16 patients with lymphoma who underwent clinical and pathologic staging. The results of the ultrasound examinations were correlated with the pathological findings as were the results of gallium-67 scans, inferior vena cavagrams and lymphangiograms obtained in the same group. Analysis of the data indicated accuracies in the 80-90% range and specificities of greater than 90% for ultrasound. The sensitivity of ultrasound was somewhat lower, in the 60-70% range. These findings compare favorably with those of the other diagnostic procedures evaluated and indicate the usefulness of ultrasound in the staging of lymphoma.