The computed tomographic (CT) findings in 52 patients with histologically proved esophageal carcinoma were reviewed. In 30 of these patients, the CT findings were correlated with findings at surgery or autopsy. CT was found to be highly accurate in predicting tumor size and assessing invasion of the tracheobronchial tree and spread to the liver, adrenals, and celiac and left gastric nodes. By quantifying the contact between the tumor and aorta, it was found that the CT appearance correctly predicted the presence or absence of aortic invasion in 24 of 25 cases (five cases were indeterminate). CT was insensitive in detecting metastatic spread to local periesophageal nodes; in these cases the tumor tended to involve the nodes without enlarging them. CT is an accurate method for assessing the spread of esophageal carcinoma. Its use can prevent unnecessary surgery in patients with inoperable tumors.
Nasoenteric tube feeding is a widely used alternative to parenteral intravenous nutritional support or gastrostomy tube placement. Unmonitored tube passage may result in complications and delays the beginning of tube feedings. The authors studied the results of 882 fluoroscopically guided feeding tube placements in 448 patients in 1 year to determine rates of success and complications, as well as the long-term outcome of this population of patients. Seven hundred sixty-four attempts (86.6%) were successful in positioning the tube distal to the third portion of the duodenum. Four major complications (three fatal arrhythmias and one tracheobronchial injury) were encountered. Only seven patients (2%) experienced aspiration events that were due to positioning of the tube in the distal duodenum. Seventy-seven percent of patients required either one or two tubes; the average "tube life" was 7.8 days. Most repositionings were required because of patient noncompliance or inappropriate administration of solid medications. Fluoroscopically guided nasoenteric tube passage is safe, easily performed, and highly successful, and has resulted in widespread clinical acceptance in our institution.
With the advent of computed tomography, lymphomatous involvement of sites other than lymph nodes is being seen with increasing frequency. Review of computed tomographic scans in 400 patients with newly diagnosed or recurrent non-Hodgkin lymphoma revealed 37 patients to have involvement of 56 unusual sites below the diaphragm: psoas/iliacus muscle (16 patients), kidney (13 patients), pancreas (5 patients), adrenal (4 patients), skin/subcutaneous tissue (4 patients), abdominal wall musculature (4 patients), peritoneum (4 patients), omentum (3 patients), and female reproductive tract (3 patients). These were mostly seen in patients with lymphomas of diffuse architecture, especially diffuse histiocytic lymphoma. Concomitant retroperitoneal and/or mesenteric adenopathy was very common; extranodal involvement was rarely the only site of initial or recurrent lymphoma.
Of 815 renal masses studied by computed tomography (CT), 60 did not fit the criteria for cyst or neoplasm and thus were called indeterminate. When artifacts were present, the likely diagnosis was a simple cyst; when no artifacts were present to explain atypical features in cyst-like masses, further investigation was necessary. Angiography was useful in only 16%, while ultrasound combined with cyst aspiration was diagnostic in 84%. All solid lesions required surgical investigation. Ultrasound with or without aspiration is recommended for all cyst-like renal masses thought to be indeterminate on CT.
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