Metastasis to the internal mammary lymph nodes adversely affects the disease-free interval and long-term survival in women with breast carcinoma. Since staging of disease in this lymphatic chain is rarely performed at the time of definitive surgical treatment, noninvasive methods have been advocated. The authors present their preliminary experience with a sonographic technique for evaluating the internal mammary lymph nodes, artery, and vein. Longitudinal and transverse images of the first through fourth parasternal rib interspaces were acquired with a 5.0- or 7.5-MHz linear-array real-time system. The method was evaluated prospectively in 36 control subjects and in seven patients (six with metastatic breast cancer and one with lymphocytic lymphoma) who had enlarged internal mammary lymph nodes at thoracic computed tomography (CT). The longitudinal scans routinely demonstrated the internal mammary vessels in the upper interspaces. Lymphatic structures were not identified in the control group. In contrast, sonographic findings corresponding to the CT findings of lymphadenopathy were present in all seven patients. The authors believe that parasternal sonography is a promising technique that merits further study.
We prospectively examined 103 consecutive adults (67 women, 36 men; mean age: 58.7 years) referred for abdominal and pelvic computed tomography (CT) in whom there was no history of right lower quadrant symptoms or appendectomy. Contiguous 5-mm CT images through the pericecal region were obtained in each subject, once routine scanning was completed. Three radiologists reviewed all CT images and reached a consensus on appendiceal visualization and the quantity of intraperitoneal fat. Statistical methods were applied to the collected data to seek significant associations between a visualized appendix and the following factors: patient age, sex, intraperitoneal fat grade, and the presence of oral contrast in the cecal lumen. The appendix was definitely visualized in only 45 of the 103 patients (43.7%). Analysis of variance revealed no statistically significant correlation between a CT-demonstrated appendix and the four variables examined. The clinical implications of these findings are discussed.
Emphysematous pyelonephritis is a rare gas‐producing bacterial infection of the renal parenchyma seen primarily in patients with diabetes mellitus. Sonographic findings in four patients with this disease are described. Sonographic features consist of multiple high‐amplitude echoes within the renal parenchyma, renal sinus, and/or perirenal space accompanied by acoustic shadowing. Computed tomography confirmed bilateral involvement in one case. Plain abdominal radiographs demonstrated abnormal extraluminal gas in three of four cases. The role of sonography in diagnosis is discussed.
Two neonates had unusually rapid development of necrotizing enterocolitis within 24 hours of birth. Both patients had decreased systemic perfusion secondary to aortic atresia. Onset of either clinical or radiographic manifestations of necrotizing enterocolitis in the first day of life should alert one to the possible presence of severe left ventricular outflow obstruction.
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