AJR. American journal of roentgenology
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AJR Am J Roentgenol · Sep 1989
The value of CT in detecting bowel perforation in children after blunt abdominal trauma.
In this era of conservative management for most infants and children with blunt abdominal trauma, there is a concern that the diagnosis of bowel perforation may be missed or delayed. To determine the sensitivity of CT in the detection of perforated viscus in this population, we reviewed the CT examinations of 547 consecutive children who had had blunt abdominal trauma. Of six patients (1%) with documented bowel perforation, four (67%) had free intraperitoneal air detected preoperatively by CT. ⋯ The remaining five patients had pneumoperitoneum from sources other than bowel perforation including pneumomediastinum, bladder perforation, and previous peritoneal lavage. This experience shows that the CT finding of pneumoperitoneum is useful, although not specific for the detection of bowel perforation in children with blunt abdominal trauma. When free air is not present, secondary signs of bowel wall thickening and unexplained peritoneal fluid suggest a bowel perforation.
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AJR Am J Roentgenol · Sep 1989
Bronchial impaction in lobar collapse: CT demonstration and pathologic correlation.
Bronchial (or mucoid) impaction refers to the accumulation of inspissated secretions (mucus and/or inflammatory products) within a bronchus, usually accompanied by bronchial dilatation. This process may be caused by abnormal mucociliary transport and excessive production of mucus. In other cases, a discrete lesion may be present that obstructs the bronchus with inspissated secretions accumulating distal to the obstructing lesion. ⋯ On CT, the impacted bronchi, best seen on postcontrast images, appeared as relatively low-attenuation branching structures extending from the hilum peripherally into the more opaque enhancing atelectatic lung. In the three patients who had surgical resection of the involved lobe, pathologic examination confirmed the dilated bronchi, filled with mucus (one patient), fibrinopurulent exudate (one), or mucous plugs with Aspergillus hyphae (one). This unique pattern of impaction within a collapsed lobe should be recognized on CT and prompt a search for a possible central obstructing lesion.
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AJR Am J Roentgenol · Jun 1989
Stab wounds of the renal artery branches: angiographic diagnosis and treatment by embolization.
Renal artery branch injury resulting from stab wounds of iatrogenic origin or street violence is an important cause of renal hemorrhage. Over a period of 10 years we accurately diagnosed the injury and successfully managed the associated hemorrhage in 15 patients by using angiography and percutaneous embolization techniques. Nine branch injuries in eight patients were due to street knifings and seven injuries were complications of invasive medical procedures (four from renal biopsy, two from nephrostolithotomy, and one from nephrostomy). ⋯ Renal tissue loss was small to moderate (less than 30%) in 12 patients and large (30-50%) in three patients. Transient postembolization hypertension occurred in one of the latter. We consider selective angiography/embolization to be an effective and safe means for diagnosing and treating wounds of the renal artery branches.
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AJR Am J Roentgenol · Mar 1989
Pseudoaneurysm and arteriovenous fistula after femoral artery catheterization: association with low femoral punctures.
We determined the location of arterial injury in 11 patients who had pseudoaneurysms with (six cases) or without (five cases) arteriovenous fistula as a complication of cardiac catheterization. Medical records and arteriograms were examined retrospectively. ⋯ Although we did not determine the location of arterial puncture used in uncomplicated angiograms during the 5-year study period, our experience in 11 patients with pseudoaneurysms with or without arteriovenous fistula suggests that there is an association between a puncture site below the level of the femoral head and arterial injury. In addition, arteriovenous fistulas appear to be associated with simultaneous catheterization of the femoral artery and adjacent femoral vein.
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AJR Am J Roentgenol · Mar 1989
Duplex Doppler sonography of renal transplants: lack of sensitivity and specificity in establishing pathologic diagnosis.
Recent reports have suggested the value of duplex Doppler sonography in the assessment of renal transplant function. Accurate diagnosis of acute rejection and its distinction from acute tubular necrosis and cyclosporine A toxicity have been claimed. We undertook a combined retrospective and prospective analysis of duplex Doppler examinations performed over a 2-year period to assess the value of such studies in evaluating renal allograft dysfunction. ⋯ Correlation between the resistive index and the severity of arterial and arteriolar changes on biopsy was poor. An increased resistive index of renal transplant blood flow, as measured by duplex Doppler sonography, usually signals pathologic changes in an allograft. However, our data indicate that this test is not as sensitive or specific in identifying the cause of transplant dysfunction as has been suggested previously.