Angelchik anti-reflux device: radiographic appearance of complications

The authors report 8 cases of erosion of an Angelchik anti-reflux prosthesis into the stomach. Erosion is detected by the appearance of the smooth contour of the device in the stomach. One device migrated distally.     

Spiral CT following the Whipple procedure: distinguishing normal postoperative findings from complications

Following a Whipple procedure for a patient with pancreatic cancer, postoperative imaging with CT is essential to exclude complications and to identify recurrence. Accurate interpretation of these examinations requires knowledge of the type of surgery performed and the normal appearance of the abdomen on CT following this complex surgery. The purpose of this pictorial essay is to illustrate the normal appearance of the bowel following a Whipple procedure as well as some of the complications.     

The immature lung: radiographic appearance, course, and complications

Thirty-six premature newborn infants of a very low birthweight (1,500 g or less) are described who did not have respiratory distress syndrome (RDS) by clinical criteria or by biochemical analysis of pulmonary effluent phospholipid (surfactant). Such patients seem to be protected against the development of RDS by intrauterine stress, which results in accelerated maturation of the surfactant system. Chest radiographs in these patients show a pattern of fine, diffuse granularity together with mild congestion suggesting excessive lung fluid, without significant air bronchograms, underaeration, or cardiomegaly. The most frequent complications are apnea with bradycardia and/or a significant left-to-right shunt through a patent ductus arteriosus. The serious complications of intraventricular hemorrhage, bronchopulmonary dysplasia, and death are more common in the smaller (1,000 g or less) infants; necrotizing enterocolitis, observed in 25% of patients, was not related to birthweight. The radiographic and clinical presentation of "immature lung" should be distinguished from that of RDS, because the prognosis in this birthweight range is considerably better (83% survival).     

The radiographic appearance of complications following Nissen fundoplication.

Seventy patients had an upper gastrointestinal examination following Nissen fundoplication for reflux esophagitis associated with hiatal hernia. Thirty-nine were asymptomatic and the fundoplication appeared normal. Of the 31 patients with symptoms (dysphagia, pain, or vomiting), 15 had spontaneous relief and demonstrated a normal postsurgical radiographic appearance of the stomach. The other 16 had both persistent symptoms and radiographic abnormalities, including 5 stenoses, 3 recurrent hernias, and 8 pouch deformities of the fundus. The roentgenographic features and etiology of these surgical failures are discussed and the importance of the radiographic examination in discerning successful surgical repair from failure despite similar postsurgical symptoms is stressed.     

Automatic implantable cardioverter-defibrillator: radiographic appearance

The automatic implantable cardioverter-defibrillator is used in patients with ventricular tachyarrhythmias resistant to medical or surgical therapy. The device, which has a unique radiographic appearance, senses ventricular tachycardia or fibrillation and automatically delivers a cardioverting or/defibrillating electric shock.     

Pulmonary aspergillosis: unusual radiographic appearance

Three cases of pulmonary aspergillosis are reported in which a seldom-mentioned radiographic feature was seen, namely, a stable, well-defined nodule or mass. The diagnosis of aspergillosis was based on results of transthoracic needle aspiration biopsy. Computed tomographic scans obtained before biopsy revealed no evidence of underlying cavitary disease. Two patients had hemoptysis. The nodule in the third patient was found on a routine chest radiograph.     

CT of the abdomen after the Whipple procedure: value in depicting postoperative anatomy, surgical complications, and tumor recurrence

We performed a retrospective study of CT scans in 29 patients who had undergone the Whipple procedure (radical pancreaticoduodenectomy) to study the CT appearance of the postsurgical anatomy and assess the use of CT in the evaluation of early postoperative complications and recurrent tumor. In the postoperative period, the scans from 15 patients revealed seven transient fluid collections; four deep abscesses, three of which were successfully drained under CT guidance; three superficial abscesses; and five cases of ascites. In 19 patients, CT scans were obtained up to 4 years after surgery to search for recurrent tumor. The most frequent site of recurrence was the liver. CT correctly identified liver metastases in six of seven patients and was falsely positive in one. Recurrence also was found twice in retroperitoneal lymph nodes; one time each in the mesenteric root, spleen, and lung base; and twice causing afferent loop blockage. Surgical proof of recurrence was obtained in eight cases. Our experience suggests that an understanding of the normal postoperative anatomy following the Whipple procedure is essential in evaluating postoperative CT scans. Scans obtained for detection of tumor recurrence should be optimized for imaging the liver because this was the most frequent site of recurrence.     

Sinus lift procedure of the maxilla in patients with inadequate bone for dental implants: radiographic appearance

OBJECTIVE: Dental implants have gained popularity for treating edentulism, but some patients develop jaw atrophy, which leaves insufficient bone for implants. To treat these patients, the sinus lift procedure, which augments bone, was developed. Altered anatomy from this procedure has an unusual radiographic appearance, confusing those unfamiliar with it. We describe the sinus lift procedure and its radiographic appearance. CONCLUSION: With knowledge of this surgery and some of its pitfalls, radiographs can be more easily and accurately interpreted.     

Hemorrhagic complications after Whipple surgery: imaging and radiologic intervention

OBJECTIVE: The aim of this pictorial essay is to illustrate the radiologic patterns, sites of bleeding, and vascular interventional techniques used in the management of postpancreatectomy hemorrhage. CONCLUSION: Hemorrhagic complications occur in fewer than 10% of patients after Whipple pancreatoduodenectomy but account for as many as 38% of deaths. Bleeding typically occurs from the stump of the gastroduodenal artery, but other sites of bleeding are increasingly recognized.     

Posttraumatic intestinal stenosis: radiographic and sonographic appearance

We report a case of posttraumatic intestinal stenosis (PIS), an uncommon sequela of blunt abdominal trauma, in which injury to the mesentery and bowel wall results in later focal ischemic stricture of that segment. We include CT images at the time of trauma, and barium meal and abdominal sonography obtained during the subsequent admission. Examination of the resected bowel loop showed transmural infarct and posttraumatic changes in the adjacent peritoneal fat. This is the first report which includes both imaging at the time of trauma and sonographic appearance of the narrowed bowel loop. Posttraumatic intestinal stenosis should be considered in the differential diagnosis of a narrowed bowel loop in a patient with a history of blunt abdominal trauma. Received 19 March 1996; Revision received 24 May 1996; Accepted 9 July 1996     

Central haemangioma: variance in radiographic appearance

Central haemangioma, a "great mimicker" which, fortunately, is a relatively rare condition, may pose a lethal risk for the patient. The diagnosis may become apparent only during biopsy or tooth extraction, which poses a risk of lethal exsanguination; therefore a correct diagnosis is desirable before any biopsy is undertaken. The clinician may not anticipate the severe haemorrhage because of vague clinical history, physical findings and ambiguous radiographic characteristics of the lesion. We report a case of central haemangioma of the mandible whose clinical and radiographic features were equivocal. In addition, an attempt is made to discuss all possible radiographic presentations of central haemangioma and consider differential diagnosis. This case is significant for the reason that it had diverse radiographic appearances in various areas of the lesion in different projections.     

Dorsal fracture of the hamate: distinctive radiographic appearance

Six patients who injured their wrists had radiographs documenting a dorsal, 5- to 10-mm oblong fragment of bone immediately proximal to the base of the fourth and/or fifth metacarpal bones. The fragment was seen on the pronation oblique and/or lateral projections, but not on the posteroanterior projection. The radiographic appearance of the fragment was remarkably similar in all cases. In the one patient in which it was performed, pluridirectional tomography demonstrated that the fragment originated from the dorsal surface of the hamate. Five of the six patients also had associated posterior dislocation of the fourth and/or fifth metacarpals. We conclude that this fragment represents a coronal fracture through the body of the hamate resulting from posterior dislocation or subluxation of the fourth and/or fifth metacarpal.     

Virtual Whipple: preoperative surgical planning with volume-rendered MDCT images to identify arterial variants relevant to the Whipple procedure

OBJECTIVE: The purposes of this study were to combine a thorough understanding of the technical aspects of the Whipple procedure with advanced rendering techniques by introducing a virtual Whipple procedure and to evaluate the utility of this new rendering technique in prediction of the arterial variants that cross the anticipated surgical resection plane. CONCLUSION: The virtual Whipple is a novel technique that follows the complex surgical steps in a Whipple procedure. Three-dimensional reconstructed angiographic images are used to identify arterial variants for the surgeon as part of the preoperative radiologic assessment of pancreatic and ampullary tumors.     

Automatic implantable cardioverter-defibrillator: appearance and complications

The automatic implantable cardioverter-defibrillator (AICD) can revert life-threatening arrhythmias to normal rhythms in ambulatory patients. The device continually monitors cardiac rhythm, and delivers cardioverting discharges when potentially life-threatening arrhythmias are recognized. The radiographs of 22 patients were reviewed with special reference to complications of radiologic interest, including pneumothorax, infiltrate, pleural effusion, atelectasis, and malposition of sensing or defibrillating leads. The normal radiographic appearance, surgical implantation, and clinical aspects of the AICD are discussed. A potential pitfall, an apparent connection gap at the epicardial electrode, was seen in three patients. This is due to limited radiodensity of part of the conduit. The AICD can lead to substantial improvement in survival rates of properly selected patients. Increasing use is probable, and radiologists should be aware of the normal appearance and complications of the AICD.     

Fallopian tube occlusion with silicone: radiographic appearance

A new method of tubal occlusion for sterilization, which is both promising and potentially reversible, is undergoing clinical trials nationwide. At hysteroscopy, a catalyzed silicone rubber compound is instilled in the fallopian tubes where it hardens to form a radiopaque plug. Radiologists may assist the gynecologist in confirming adequate initial formation of the plug and with follow-up radiographs. Radiologists not involved in the procedure may see the radiopaque plugs on radiographs obtained for other clinical purposes, and they should be aware of this new method of sterilization.