Radiology
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Acute bacterial (suppurative) otomastoiditis responds to antibiotic treatment; radiologic study is required only when there is clinical suggestion of coalescent mastoiditis, intracranial complications, or an underlying chronic disease. Computed tomography (CT) is the method of choice for evaluating otogenic intra- or extra-cranial complications. CT scans can show stages of disease progression when infection has spread by way of soft tissue, blood, and bone pathways into the dural venous sinuses, meninges, labyrinth, facial nerves, epidural and other intracranial spaces. When there is clinical suggestion of acute coalescent mastoiditis, a CT scan of the temporal bone can confirm the presence of rarefying osteitis, coalescence of the air cells, and subperiosteal abscess.
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Intraoperative ultrasound scanning of the spinal cord and spine was performed during 36 operations in 35 patients. The technique allows neurosurgeons to evaluate an operative procedure during the operation. Effectiveness of shunt placement in syringomyelia can be detected and the completeness of tumor or disk removal can be determined. ⋯ Periodic motion of the spinal cord at the cardiac rate was also detected. This motion was usually due to transmitted pulsations from the anterior spinal artery and appeared to be most pronounced when the artery was compressed between a mass and the spinal cord. This finding refutes the commonly held idea that spinal cord motion implies that the cord is free within the thecal sac.
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Although uncommon, meconium peritonitis can present with a scrotal mass. Usually calcified, this mass may be the initial or only sign of meconium peritonitis. We detected such a scrotal mass prenatally with ultrasound.
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Case Reports
Mediastinal lymphadenopathy and pulmonary arterial hypertension in mixed connective tissue disease.
A case of mixed connective tissue disease (MCTD) is presented in which mediastinal lymphadenopathy was the most prominent radiological finding detected by plain chest radiographs and computed tomography. Pulmonary arterial hypertension, which is a rare and often fatal complication of MCTD, also developed in this patient.
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To evaluate the relationship between extravascular lung water, pulmonary capillary wedge pressure, and chest radiographic findings, extravascular lung water (EVLW) was assessed using double indicator-dilution techniques in 34 adult patients with mitral stenosis. Seven patients were studied 6 to 12 months after successful mitral valve replacement. In the 27 preoperative patients, septal lines were found to be indicative of elevated EVLW only in the presence of intravascular congestion. ⋯ Postoperatively, septal lines were invariably associated with normal filling pressures and EVLW. Thus in both preoperative and postoperative mitral stenosis patients, interstitial Kerley B lines are insensitive markers of elevated extravascular lung water in the absence of pulmonary vascular engorgement. This emphasizes the importance of interpreting radiographic findings of extravascular fluid in conjunction with evaluation of the vascular bed in patients with chronic postcapillary hypertension.