C. The causative pathogen of phlegmonous infection in our patient is believed to be Klebsiella pneumoniae, based on positive culture results on blood, sputum and pleural fluid. However, recurrent tumor tends to manifest as more irregular narrowing, asymmetric mass effect, and ulceration. It is a serious condition, with reported mortality rates ranging from 30% to 50% (16). Patient had dysphagia for solids, previous food impactions, and an atopic history. How is low grade dysplasia managed? C.

However due to low sensitivity and specifity its role in the diagnosis remains undetermined [11] . Change size and shape during fluoroscopy, smooth contours. Endoscopic findings are less helpful in scleroderma and the spastic disorders of nutcracker esophagus and diffuse esophageal spasm, as the findings are often normal with these entities. 1000 mL of Mannitol (2.5%) was administered to all patients as a negative oral CT contrast agent. Pulmonary artery stenosis can occur early and late after lung transplantation.[23] Patients may present with shortness of breath, hypoxia, signs of pulmonary hypertension, and right heart failure, and non-resolving pulmonary opacities secondary to infarction on radiographs and CT []. Reduced/absent folds in fundus and body (‘bald fundus’), narrowed tube-shaped stomach (fundus narrowed antrum with nodular ‘cobblestone’ pattern. Although SCLC is less common than the other type of lung cancer, it is a more aggressive tumor that is more likely to spread to other body sites.


The eggs hatch into nonmigratory rhabditiform larvae, which penetrate the intestinal mucosa and are excreted in the feces. Gastrohepatic ligament, D. Combined evaluation by a gastroenterologist and allergist to diagnose EoE and the potential food allergens triggering the condition, followed by a plan for reintroducing foods in the future. The hallmark of obstruction on plain films (obviously) is dilated loops of bowel. Symptoms of dysphagia and regurgitation can be reported by patients, particularly those with diverticula related to diffuse esophageal spasm or achalasia. Late gastric band erosion occurs in 0.3 to 14% of patients9 with variable clinical presentations. William BM, Corazza GR.

Radiographic barium study of primary achalasia shows complete absence of normal esophageal peristalsis usually extending through the entire esophagus, though rarely only the distal two-thirds is involved. Despite publication of these reports, the practice of obtaining chest X-rays in such children with fever and neutropenia continues. Causes of complications are varied, ranging from technical problems to host immune response and predisposition to infections. American Journal of Roentgenology. Butt et al[7] concluded that basal and papillary epithelial eosinophil eotaxin expression, with focal lymphocyte activation, often is present in infants with cows’ milk allergic esophagitis-associated GER. FDG PET scanning should be delayed for 8 weeks after surgery, when possible, to reduce FDG-avid postsurgical changes that can interfere with scan interpretation (1,2). In comparison with these procedures, LAGB has several advantages: It is minimally invasive, involves no incision or stapling of the stomach or small bowel, and is associated with a lower risk for malnutrition.

Figure 4-3 Esophagogram with barium paste according to the mucosal relief technique demonstrates multiple serpiginous filling defects (arrows) in the mid and distal esophagus, compatible with esophageal varices. The typical radiographic pattern observed in HIV-infected patients with Kaposi sarcoma (KS) consists of poorly defined nodular opacities approximately 1-2 cm in diameter scattered throughout both lungs. The segments of the liver are demonstrated as well. Using a thin-barium technique, radiographic appearances of esophageal varices were described first by Wolf in his 1928 paper, “Die Erkennug von osophagus varizen im rontgenbilde,” or “Radiographic detection of esophageal varices.” [3] In 1931, Schatzki established the basis for the modern-day fluoroscopic detection of esophageal varices by refining positional and physiologic maneuvers to optimize visualization. Aspiration precautions are important in those with severe esophageal dysmotility. Most IgG4-related sclerosing diseases have been associated with auto-immune pancreatitis (AIP), but in some cases, IgG4-related sclerosing diseases without AIP and involving only one or two organs have been reported. Oral and pharyngeal involvement occurs in the immunocompromised and not in the immunocompetent patient.

Barium esophagogram showed diffuse stenosis at the mid and lower esophagus levels with ulcerations and irregularity of the mucosa. 1977 ,p 10. Among 6 cases in this series, all cases were confirmed by Shenzhen Center for Disease Control and Prevention (CDC) to be HIV positive and all of them had CD4 cell counts less than 150 × 10(6)/L. CT permits the detection of the main infectious pattern and associated findings with high confidence and allows for the precise assessment of all involved structures, to potentially guide a bronchoalveolar lavage or another diagnostic procedure, and to ensure a reliable follow-up. New videos on a DVD take you step by step through the following modalities: CT colonography, PET/CT, 3D applications of MDCT, and MR angiography. The book provides an overview of diseases involving multiple organs as well as the radiologic evaluation of common clincal problems. BACKGROUND: Candidal esophagitis is the primary infection among all digestive tract opportunistic ones in acquired immunodeficiency syndrome (AIDS) cases.

B. Phlegmonous infection can affect any site of the gastrointestinal tract, although the stomach is most frequently involved (1-3). Because Barrett esophagus is a premalignant condition associated with an increased risk of developing esophageal adenocarcinoma, many investigators advocate endoscopic surveillance of patients with known Barrett esophagus to detect dysplastic or early carcinomatous changes before the development of overt carcinoma (18). (a) Contrast-enhanced CT image shows esophageal wall thickening (arrow) and a posterior mediastinal air-fluid collection (arrowhead) abutting the esophagus. Endoscopy reports were also reviewed for the presence or absence of a small-caliber esophagus, ringed esophagus, esophagitis, or strictures in six of the 10 patients (60%). Can esophagitis be prevented? B.

The presence of reflux esophagitis is expected to reduce, especially, distal esophageal infection. Recurrence of primary disease in the allograft may appear as early as 2 weeks or as late as 2 years after transplantation. Progressive atrophy of smooth muscle and progressive fibrosis. 2009 Oct. Symptoms include heartburn, dysphagia due to stricture or esophageal dysmotility, and pain due to diffuse spasm. To further elaborate this issue, the aim of this study was to retrospectively compare the capability of PET alone, low-dose CT (ldCT), and contrast-enhanced CT (ceCT) for further differentiation of suspicious incidental gastrointestinal FDG uptake in patients with a routine PET/CT protocol including ldCT and ceCT. Key risk factors predisposing to airway-related complications include donor bronchus ischemia caused by disruption of native bronchial circulation, followed by recurrent rejection and infection.

Barium may penetrate abscess crypts. See the Intensity-Modulated Radiation Therapy (IMRT) page for more information. Areas where there is abnormal cellular activity, such as in cancers and inflammation, pick up more of the tracer. Unenhanced CT and magnetic resonance (MR) imaging of the brain (Fig 3) showed severe diffuse atrophy, a finding that was inconsistent with the patient’s age, and areas of high attenuation or high signal intensity in the white matter, a nonspecific finding that may be seen with small vessel ischemic change. Also, the patent processus vaginalis is usually tubular, whereas the protrusion of peritoneum into the femoral canal is usually globular. The intussusceptum forms the inner part of the bull’s eye, while the intussuscipiens forms the outer layer. Hepatorenal recess (Morrison’s pouch), C.

(A) represents ascites in the peritoneal cavity, (B) is the bare area of the liver, (D) is the diaphragm, and (P) is pleural effusion. In Freeny PC and Stevenson GW, eds.: Margulis and Burhenne’s Alimentary Tract Radiology, 5th Edition. Otherwise, when EoE is suspected, patients are usually placed on medication for acid blockade and subsequently undergo an upper endoscopy with biopsy. An advanced type of radiography called barium contrast radiography may reveal changes in the esophagus due to inflammation. Associated gastrointestinal infections included candida and herpes, and, in addition, pneumocystis carinii pneumonia (PCP) was present in two patients. External hernias are protrusions of bowel through defects in structures external to the peritoneal cavity (e.g. Note that a normal barium transit time through the small bowel is 30 min.

The cephalocaudad extent of the image should be from the hard palate to the sterno-clavicular joints. Rotate the patient into RPO position. The commode has an adjustable footrest to recreate the patient’s usual position for bowel evacuation. The most common pharyngeal diverticula (Zenker’s) are false diverticula immediately proximal to the cricopharyngeus muscle.1 Diverticula of the body of the esophagus are divided into midthoracic (parabronchial) and epiphrenic diverticula. In these patients, computerized tomography (CT) can be a useful guidance alternative for percutaneous gastrostomy. This exchange is performed through the relatively short first dilator (usually 6-French). Herlinger modification (Cook Inc., Bloomington, IN) or the 13 Fr., 155 cm.

Benign ulcers constitute approximately 95% of all gastric ulcers. Finally, it may be like Vesuvius, apparently extinct, apart from occasional rumbles, making its presence felt only by causing ill health. Approximately a third of American adults were clinically obese between 2007 and 2008, and the treatment of obesity-related medical conditions was estimated to cost almost $210 billion, accounting for more than 20% of U.S. Crit Care Clin. The most common causes of esophageal tear, perforation, and hematoma are iatrogenic factors. There are several important differences in children and adults with AIDS. Listed below are the specialties that currently have guidelines and forms.

The primary neurologic defect responsible for the development of primary achalasia is unknown. Data on their respiratory signs and symptoms were collected on admission and throughout their hospital course. Complications of lung transplantation may occur along a continuum in the immediate or longer postoperative period, including surgical and mechanical problems due to size mismatch and vascular as well as airway anastomotic complication, injuries from ischemia and reperfusion, acute and chronic rejection, pulmonary infections, and post-transplantation lymphoproliferative disorder. It can cause Barrrett’s esophagus, candida, hoarseness, dysmotility, ulcers, heartburn, and throat spasms. Lymphocytic esophagitis is characterized by high numbers of intraepithelial lymphocytes (IELs) gathered mainly around peripapillary fields and by none (n = 12) to occasional (n = 8) CD15+ intraepithelial granulocytes.

Fibrovascular polyps are rare benign intraluminal submucosal tumor-like lesions characterized by the development of pedunculated, intraluminal masses which in the esophagus can demonstrate enormous growth. In its localized form, an area of acute inflammation in submucosa is noted, usually affecting the gastric antrum. These strictures typically appear as ringlike constrictions or, less commonly, as smooth, tapered segments of concentric narrowing in the midesophagus (Figs 10, 11) (20). Risk factors for primary sternal osteomyelitis include intravenous drug use, acquired immunodeficiency syndrome (AIDS), and other immunodeficiency conditions (10). Because the data were not normally distributed, the dependent variable was first transformed by using a square transformation. What causes Barrett’s esophagus? Fibrovascular polyps are rare benign intraluminal submucosal tumor-like lesions characterized by the development of pedunculated, intraluminal masses which in the esophagus can demonstrate enormous growth.

pylori is obscure, H. Bronchogenic carcinoma typically occurs in the native lung at least 1 year after transplantation, with a frequency of less than 1% in the population of lung transplant recipients and of 2% and 4% in those who received a lung transplant for treatment of emphysema or pulmonary fibrosis, respectively (39,40). Lateral pharyngeal diverticula – Mucosa through weakened lateral pharyngeal wall, most at tonsillar fossa and thyrohyoid membrane. A discussion of esophageal diverticula is included in this chapter because they can result from dysmotility, and because the primary symptom of esophageal diverticula is dysphagia. 5045 18F-FDG-PET/CT scans performed in our department between January 2005 and May 2011, were reviewed retrospectively for patient examinations with suspicious incidental FDG uptake in the gastrointestinal tract. (A and B) Coronal and axial CT images in lung windows show focal air collection in mediastinum adjacent to anastomosis (black arrows). Most from caustic ingestion, surgery, trauma or ischaemia.


This may help to relieve severe symptoms but does not cure the cancer. Interventional radiology offers minimally invasive alternatives to surgery, utilizing image-guided techniques to treat a wide range of conditions, including cancer, fibroids, varicose veins, and kidney disease, usually on an outpatient basis. Analysis of a cerebrospinal fluid sample showed 59 white cells with 98% lymphocytes, elevated glucose and protein levels, and Strongyloides larvae. Perisplenic space, G. It may also help differentiate the nature of the ascites as simple ascites is anechoic whereas ascites with hemorrhagic, exudative, or neoplastic components may have floating debris. Shorvon PJ, McHugh S, Deamant NE, Somers S, Stevenson GW: Defecography in normal volunteers: results and implications. Typical allergy tests, such as skin prick tests or blood tests (ImmunoCAP or RAST) may identify immediate allergic reactions, but are not always effective in determining which foods are responsible for EoE.

Endoscopy is an internal diagnostic tool which uses an endoscope, a rigid but flexible tube equipped with a camera and methods for retrieving tissue samples, that can be inserted into a hollow cavity, such as the esophagus. Incarceration of a hernia confers that the hernia is not reducible. With the application of these techniques, the modified barium swallow is both an evaluative and a rehabilitative procedure. Accurate reproduction of the physiologic conditions of defecation requires the use of a contrast material with the consistency of normal stools – that is, semisolid and malleable. In patients undergoing radiologic evaluations for dysphagia, Zenker’s diverticulum was found in 2.3%.4 The prevalence of Zenker’s diverticula among the general population is believed to be between 0.01% and 0.11%,5 with the majority of patients diagnosed being older than 70 years of age. Despite the numerous etiologies, all benign ulcers share the common pathophysiology of a disrupted mucosal barrier in the presence of increased acid production, and are collectively referred to as peptic ulcer disease . A framework for the book is homeostasis and how the body maintains balance within each system.

This article will highlight the clinical features of gastric restrictive surgery relevant to the radiologist and review the radiologic appearance of normal and complicated LAGB and LSG. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. Note the increased soft tissue prevertebral space and air in the soft tissues (same patient as in previous image). In this publication the complications of pediatric AIDS involving the lungs, cardiovascular system, gastrointestinal tract, genitourinary system, and neurological system are described. Secondary or pseudoachalasia has many etiologies, but is most commonly malignancy induced. None of the children with normal respiratory findings hospitalized for the remaining 98 episodes had pneumonia. The indications for transplantation span the spectrum of pulmonary diseases [Table 1].

It affects the skin and various internal organs. Only 4 (20%) of 20 patients had symptoms of gastroesophageal reflux disease and 6 (30%) of gastroduodenitis; 2 (10%) had celiac disease; 4 (20%) had carcinoma of the esophagus (1) or elsewhere (3); 1 (5%) each had hiatus hernia, gastric ulcer/asthma/blood hypertension, Hashimoto thyroiditis, and cirrhosis/diabetes; and 8 (40%) had Crohn disease. Five biopsies were positive for CMV by H&E stain and immunoperoxidase.

The pedicle of the mass (curved arrows) is visible. We consider that uncontrolled diabetes mellitus and a recent history of chest trauma in combination with excessive alcohol consumption played an important role in the development of the disease in our patient. Certain chemotherapeutic agents such as adriamycin can potentiate the effects of radiation therapy, so that affected individuals may develop strictures with doses of mediastinal radiation as low as 500 cGy (24). (b) Contrast-enhanced CT image, obtained at a different level, shows a mediastinal fluid collection (arrowheads). The small-caliber esophagus, therefore, was manifested radiographically by long-segment but variable-length narrowing that extended from the thoracic inlet, aortic arch, or left main bronchus distally to the left main bronchus, left atrium, or gastroesophageal junction. Why is it important to screen patients with GERD to diagnose Barrett’s esophagus? The pedicle of the mass (curved arrows) is visible.

Endoscopy has been considered as the method of choice for diagnosis [11],[20],[36] . Rare, usually associated with motility disorders. The latter term is particularly confusing, as many authors18,25,31,39 use the term felinization to describe a normal endoscopic variant, defining it as transient, fine, circumferential esophageal folds, 1 to 2 mm in thickness and symmetric, predominately in the distal two thirds of the esophagus (Figure 11).39 The folds disappear with air overinsufflation. These patients were finally included in the study (mean age: 65 years, range: 41-85 years, 23 female, 37 male). Right lung transplant with recurrent right lower lobe collapse. Normal or reduced gastrin (hypogastrinemia). Evidence is mounting that a combination of these drugs integrated with radiotherapy is more effective than radiotherapy alone, but there is a substantial risk of serious side effects.

We also understand that patients often have many questions about the procedures and results, and our knowledgeable staff will take the time to address each concern. S stercoralis is a nematode whose primary hosts are humans. This space is normally collapsed but can massively expand when filled with fluid (ascites, blood, pus). Hiltunen K-M, Kolehmainen H, Matikainen M: Does defecography help in diagnosis and clinical decision-making in defecation disorders? Allergy tests may not be able to determine the problem foods. Intussusception is the telescoping of bowel to form inner loop (intussusceptum) and outer loop (intussuscipiens). Recording Equipment.

Aspiration pneumonia, halitosis, and gurgling in the throat may also be present. The normal Φ angle (the angle between the band and the spinal column) ranges 4–58°. JAMA. Many conditions can result in mediastinal fluid, esophageal thickening, mediastinitis, and extraluminal air within the mediastinum, all of which provide a potential for misdiagnosis. A variety of neurological abnormalities may occur in pediatric AIDS. It is important to evaluate patients in the recumbent, usually prone oblique position, as well as in the erect position [2]. [See editorial on pages 1009-10, this issue.] Cancer 1997; 80:1160-4.

[4] Although lung transplantation is a well-established procedure, complications are frequent. Our results, in accordance with previous published data suggesting an increased risk of EAC or cardial adenocarcinoma in SSc, highlight the need for accurate follow-up of BE SSc patients at risk of developing adenocarcinoma. As a result of the inflammatory process, the mucosa may become gradually eroded or ulcerated (grade 3 esophagitis). We conclude 1) CMV infection of the esophagus is common in AIDS patients with esophageal ulcer or esophagitis resistant to antifungal therapy; 2) multiple infections or neoplasms may coexist; 3) since CMV apparently does not infect squamous epithelium and only rarely endothelium in stromal papillae, deep biopsies are necessary for diagnosis; and 4) immunoperoxidase staining is required for maximum diagnostic yield. In this article, we review common and uncommon benign FDG-avid lesions that result from surgery and surgical procedures, radiation therapy effects and complications, and chemotherapy effects and complications. Methods for managing various kinds of complications are also briefly discussed. To obtain single-contrast views of the esophagus, the patient is typically in the prone, right oblique position and drinks contrast medium Figure 4-1 Normal double-contrast esophagogram demonstrates good esophageal distention and coating.

Conventional bacterial pneumonias occur with increased frequency in patients with advanced HIV disease, although the incidence has declined with the appropriate use of ART.(66) Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus are among the organisms responsible for these pneumonias. (A) Cross-sectional anatomy of stomach, liver, left and right portal veins, and spleen together with correlating axial CT section (B) correlating with the same level of anatomical cut section. Note the ascites and cirrhosis. Whether reflux contributes to the pulmonary disease is an open question. Fluorine 18 fluorodeoxyglucose positron emission tomography (FDG PET) revealed diffuse mild FDG uptake in mid to lower esophagus. The deep ulcerations were oval in shape and varied in size. A.

Esopahgeal narrowing was found in all patients; it was focal in six and diffuse in two. Barium esophagogram was done that suggested a specific condition.

Throughout its course in the posterior mediastinum, the thoracic esophagus is situated adjacent to vital structures including the trachea, vertebrae, lungs, heart, blood vessels, and lymphatics. A 48-yr-old man presented with left chest pain, abdominal pain, and dyspnea of three days duration. These sacculations can sometimes be mistaken for ulcers but tend to have a more rounded appearance and a more changeable configuration at fluoroscopy. -Scarring/strictures: Scarring of the esophageal mucosa can manifest in multiple ways. Clinically, patients may present with postoperative fever and signs of local inflammation at the surgical site. Abdominal plain films may show an obstructive pattern. The site of perforation is sometimes visible as a region of discontinuity in the stomach or duodenal wall.

Endoscopic biopsy specimens helped confirm the presence of IEE (ie, more than 20 eosinophils per high-power field) in eight of those 20 patients (40%). Radiology 1987 ; 165 : 815-820 . What kinds of doctors treat esophageal cancer? Treatment is often complicated by reflux esophagitis and subsequent peptic strictures. Throughout its course in the posterior mediastinum, the thoracic esophagus is situated adjacent to vital structures including the trachea, vertebrae, lungs, heart, blood vessels, and lymphatics. Our patient did not have any history of drug intake and the biopsy material did not show any infectious agent. Twenty seven patients smoked cigarettes and three smoked shishah.

In this regard, both primary and postprimary tuberculosis have been reported. The contour defect is believed to be an early stage of a midesophageal stricture, a classic feature of Barrett’s esophagus. Abnormal oesophageal swallowing causes heartburn, dysphagia (awareness of swallowing difficulty), ‘indigestion’, chest pain. In this image, the ovoid filling defects caused by the leiomyoma. Acute odynophagia in patients undergoing systemic treatment of active PV warrants prompt endoscopic evaluation to rule out esophageal pemphigus or superinfection. Killian-Jamieson diverticula occur in a triangular area of weakness in the cervical esophagus below the cricopharyngeus muscle in contrast to Zenker’s diverticula. These neurons allow relaxation of the LES through inhibition of the normally contracted LES smooth muscle, and their loss can lead to the failure of the LES to relax with swallowing.


They can be small plaque-like lesions with central ulceration or small, sessile polyps with a smooth contour. Two CT slices demonstrating massive pneumatosis intestinalis. The PET lesions were evaluated regarding their FDG uptake patterns and the standard uptake value. Prenatal ultrasounds may reveal fluid filled structures in the abdominal cavity. However, with improvements in supportive technology and experience with transplant procedure, heart-lung transplantation has become very infrequent. Lateral films of the neck may reveal widening of the prevertebral space, anterior deviation of the trachea, or a retropharyngeal abscess with an air-fluid level. Rolling types have high risk of strangulation.

They may be multiple, but contrary to jejunal diverticula, they are usually small. The esophagus is divided into three segments: the cervical, thoracic, and abdominal segments. Our team of specialists includes pediatric radiologists, neuroradiologists, interventional radiologists, nuclear medicine specialists, nurse practitioners, technologists, nurses and child life specialists. High-density barium suspensions or paste are used to increase adherence of the barium to the esophageal mucosa. On CT, small amounts of free air may be difficult to distinguish from intraluminal bowel gas, thus lung windows should be used to help differentiate. The extension of gastroesophageal hernias are more accurately evaluated with barium studies than with endoscopy. Left untreated, the immune system and fungal spores can damage sensitive lung tissues and lead to scarring.

Use 9″ or 12″ image intensifier (II) field of view (FOV). Imaging findings are related to both active ischemia and chronic changes (fibrosis). The splenic flexure is in the watershed region the SMA and IMA and is thus the most vulnerable to ischemic insult. The majority of mesenteric ischemia is arterial in origin. In fact, it is the most common malignancy of the duodenum. A recent case series formally discusses three brothers between the ages of 34 and 44 years all with eosinophilic esophagitis.[7] Whether this provides a purely genetic basis or one combined with common environmental exposures is unclear at this time. Aspiration of barium into the airway is much easier to detect in the lateral view than it is in the frontal projection.

Transit of tablet is followed fluoroscopically. Have patient drink barium through a straw. There are many types of polyps. This can produce narrowing of the lumen down to a few millimetres in diameter. With the exception of umbilical vein catheterization in children, gas in the portal veins is a grave prognostic indicator and almost always signals imminent death. Boerhaave’s syndrome or spontaneous esophageal perforation occurs when a sudden increase in intraluminal esophageal pressure causes a full thickness perforation. 2.

The advantages of computed tomography for the evaluation of various chest lesions commonly encountered in patients with AIDS are discussed. More than one in four of all diagnosed cancers involve the lung, and lung cancer remains the most common cancer-related cause of death among American men and women.