Postpartum hemorrhage: Clinical and radiologic aspects

Postpartum hemorrhage (PPH) is a potentially life threatening condition, and it remains the leading cause of maternal morbidity. Uterine atony, lower genital tract lacerations, uterine rupture or inversion, retained products of conception and underlying coagulopathy are some of the common causes of PPH. Most conditions can be diagnosed based on clinical and laboratory evaluation supplemented by ultrasound information. Computed tomography (CT) or magnetic resonance (MR) imaging can provide information for the detection, localization and characterization of PPH in some difficult cases. CT can accurately demonstrate the anatomic location of significant arterial hemorrhage as sites of intravenous contrast material extravasation, which can be as a guide for angiographic intervention. The presence of focal or diffuse intravenous contrast extravasation or a hematoma within the enlarged postpartum uterine cavity on CT can help the diagnosis of uterine atony when the clinical diagnosis of uterine atony is unclear. CT can also provide the information of other alternative conditions such as a puerperal genital hematoma, uterine rupture and concealed hematoma in other sites. MR imaging may be considered as a valuable complement to ultrasound where the ultrasound findings are inconclusive in the diagnosis and differential diagnosis of retained products of conception. Knowledge of the various radiologic appearances of PPH and the correlation with clinical information can ensure correct diagnosis and appropriate and prompt treatment planning in the patients with PPH.     

Intestinal tuberculosis. The radiologic aspects of a disease not to be overlooked]

Intestinal tuberculosis still exists in the Western world, where it is usually underestimated and often mistaken for Crohn's ileo-colitis or cancer. The authors report the results of 4 cases of intestinal tuberculosis observed between 1983 and 1988. The cases are discussed in the light of the epidemiological data emerging from a review of recent medical literature. The danger is that the disease, which is endemic in Asian and African regions, may spread again in the Western world fostered by intensifying migrations of people and by the spreading of AIDS. According to recent experience, a negative chest film and Mantoux skin-test no longer have a negative predictive value for intestinal tuberculosis. In the radiological differentiation from Crohn's disease it is useful to keep in mind some topographic features of TBC: the systemic non-discontinuous involvement of both sides of ileocecal junctions; the unusual presence of ileal lesions, with no cecal lesions, and localizations below the transverse colon. Useful differential morphological criteria can be: star-like or transverse ring-shaped profile of isolated ulcerations, tubular ileocolic junction with retracted cecum and open valve, and uniformity of lesion in the comprehensive picture of the clinical case.     

Clinical and radiologic aspects of buerger’s disease

Buerger’s disease (BD) is an entity with distinct clinical and pathologic aspects, including etiologic factors, pathogenesis, histology, clinical presentation, course, and prognosis. Comprehensive angiographic studies support the definition of the disease’s evolution, provide information about distribution patterns (i.e., bilateral, upper and lower extremities, involvement of trunk arteries), aid in choosing “hot spots” for biopsies, and determine preoperative technical considerations in selection of bypass surgery candidates. In a series of 44 patients with BD, we endeavored to record the frequency of distribution and progression of various stages of disease as well as document the angiographic signs that are commonly accepted as typical of or specific to BD. Characteristic angiographic patterns of the disease are: corkscrewshaped collateral vessels, cutoff type vascular occlusions, vessels with smooth-lined lumina in noninvolved arteries and discontinuous, segmental involvement of affected arteries and veins. Results of pharmacoangiographic functional studies of circulatory disorders appear to cast doubt on the supposed specifity of phenomena such as standingwave pattern and vasospasm in BD.     

Parotid lymph node metastasis from adenocarcinoma of the urachus

The parotid gland and its lymph nodes are frequent sites of metastases from head and neck cancers. However, metastasis from a distant primary below the clavicle is unusual. These originate from a variety of sites, most commonly the lung, kidney and breast. A case of a 59-year-old woman with parotid lymph node metastasis from an adenocarcinoma of the urachus, diagnosed on the basis of two discrete periparotid masses on CT and the patient's history, is presented.     

The image of urachus adenocarcinoma on Doppler ultrasonography

Malignant urachal lesions are exceedingly rare and occur predominantly in adult life. In this case report, an adult patient with urachal carcinoma is presented with abdominal plain film, intravenous urography, gray-scale ultrasonography (US), Doppler US, and computed tomography (CT). Doppler US successfully showed the neovascularity with low resistive index value in the urachus tumor. We believe that Doppler US examination is helpful in the differential diagnosis of urachal carcinoma.     

脐尿管混合癌1例

1病例报告1．1一般资料患者,女,65岁,入院前3个月出现全程无痛性肉眼血尿。在他院行腹部CT检查（图1）：示盆腔前腹壁下软组织影,膀胱受压明显,其来源及性质待明确,提示膀胱肿瘤。病理活检：膀胱移行上皮细胞癌。遂来我院就诊,以“膀胱肿瘤”收住入院,行全膀胱切除术。     

The radiologic and clinical aspects of calcified hypernephroma.

The radiologic, pathologic, and clinical findings were reviewed in 18 patients with calcified hypernephroma and 6 with calcified benign renal lesions. Our results suggest: (a) that the pattern of calcification in a renal parenchymal lesion is of little assistance in diagnosis; in this series, many hypernephromas had peripheral curvilinear calcifications, and most benign renal lesions had internal amorphous calcifications; (b) that no distinct angiographic pattern exists in calcified hypernephroma, and a spectrum ranging from avascular to hypervascular may be identified; and (c) that these tumors may behave more benignly than uncalcified hypernephroma (5-year survival 78%).     

Chronic spondylodiscitis. Clinical aspects and imaging features]

INTRODUCTION: The diagnosis of a chronic inflammatory process involving the vertebral body and disk is often very difficult because patient's history, subjective symptoms and physical findings are often unconclusive. Thus imaging techniques play a decisive role. Radiography, tomography, CT and MR have different capabilities and limitations and provide different findings in spondylodiscitis. MATERIAL AND METHODS: We observed 18 cases of spondylodiscitis in the last three years. The responsible microbe, a Staphylococcus aureus from extraosseous sites, was found in two cases at blood culture. Small cell inflammatory infiltration was confirmed with CT-guided biopsy in one case, while the other cases were diagnosed based on constant chronic back pain, feveret, moderate neutrophile leukocytosis or increased erythrosedimentation speed, plus changes in radiographic patterns following antibiotic therapy. RESULTS: Plain radiography and tomography are the techniques of choice to detect or suspect the lesion, which is then studied with CT or MRI. Clear-cut irregularities and erosions on opposing vertebral bodies, reactive bone sclerosis and reduced disk space were typical signs in our series; nine patients presented irregular cavitations(s), like bone caries, surrounded by reactive sclerosis in the body near the frontal vertebral plate. CONCLUSIONS: Together with the imaging patterns of all cases, we studied in detail three cases, relative to physical findings and diagnostic techniques. We also compared the changes in chronic spondylodiscitis with those in intraspongious herniation, intervertebral osteochondritis and severe degenerative arthritis. Bone erosions on the anterior cortical surface of the vertebral body were seen in 50% of our cases and may represent a specific sign of chronic spondylodiscitis if the finding is confirmed in further studies.     

Carcinoma of the urachus.

Characteristic roentgenographic and anatomical features of a mucinous adenocarcinoma of the urachus were observed in two patients. Both presented with a midline anterior abdominal mass in the supravesicular area. The tumor contained fine stippled calcification in one case. The cystogram demonstrated an irregular filling defect in the bladder dome in the other case. Ultrasonographic examination in one case was helpful in delineating the nature, size, and location of the mass in detail.     

Papillary adenocarcinoma of the lung: radiologic and pathologic findings

We describe the radiologic and pathologic findings of papillary adenocarcinoma of the lung in three patients. The tumor appeared as a peripheral lung nodule (n = 1) or a mass (n = 2) on chest radiographs. On CT, the tumor appeared as a solitary pulmonary nodule, as a mass containing internal bubble lucencies with surrounding ground-glass opacity and satellite micronodules, and as a triangular mass with satellite micronodules. On pathology, all tumors showed distinct histologic features with papillary architecture, distortion and/or destruction of normal pulmonary architecture, and nuclear atypism.