[en] Assessment of pelvic fractures requires an understanding of the bony and soft-tissue anatomy of the pelvis. Pelvic injuries may be classified into major and minor groups. Minor fractures usually result from athletic trauma in the young or falls in the elderly and can generally be adequately evaluated with routine radiography. Major fractures are most often caused by motor vehicle accidents, falls from a height or industrial accidents and require more sophisticated examination. However, the investigation of injuries in either category should be directed by a knowledge of the history and physical findings. The classification of pelvic injuries used at Sunnbrook Medical Centre is based on mechanisms of injury

[en] Two new patients with pseudosarcoma of the esophagus are presented with the first report of the findings on computerized tomography (CT). The radiographic appearance in the two patients, with 24 previously reported, is reviewed. Barium esophagograms typically demonstrate a large, elongated polypoid mass in the middle or lower third of the esophagus that distends the lumen at the level of the lesion, but does not produce marked obstruction. There are no specific CT characteristics which differentiate pseudosarcoma from squamous cell carcinoma of the esophagus

[en] Ingestion of oral contrast material as a routine part of abdominal computerized tomographic scanning creates numerous gas and fluid interfaces within the gastrointestinal tract. Following deep inspiration or expiration, fluid motion induced by shifting intra-abdominal contents persists for several seconds. This causes radial streak artifacts to arise from air-fluid interfaces, even though respiration is suspended while the scan is made. Such artifacts can be reduced if the beginning of a scan is delayed to allow fluid motion to stop. An alternative is to re-scan an area of interest in the lateral decubitus position so as to shift air-fluid levels and their associated artifacts away from any region in question

[en] For the last two decades the most common method of radiographic study of the venous system of the lower limbs has been ascending phlebography, by injection of contrast material in a superficial vein on the dorsum of the foot. We report our own experience with another approach, using a large field technique on recumbent patients, with elevation of the limbs, thus taking advantage of gravity. The contrast injection is usually made in a more distal superficial vein of the foot after a tiny cut-down. Excellent results are consistently obtained in demonstrating all the deep veins, including the iliac vessels. The same principles may be applied to upper limb phlebography

[en] Renal digital subtraction arteriography (RDSA) is a relatively safe, simple, and inexpensive means of detecting the presence of renovascular disease in hypertensive patients. We report our own 15-month experience with RDSA, performed on 166 patients because of hypertension, and review the literature. Twenty-eight of the patients had arteriography. Using this as a measure, the sensitivity of RDSA was 83 percent and its specificity 96 percent. RDSA findings are usually conclusive. Addition of plain films following the procedure permits evaluation of renal parenchyma, collecting systems, ureters, and bladder. Arteriography should be reserved for those patients with positive RDSA to be treated by surgery or angioplasty, and for the small number of patients who have a non-diagnostic RDSA. If renal vein renin sampling is done first, RDSA may be performed at the same time. As RDSA becomes more available there will be little place for rapid sequence urography in the investigation of hypertension. In patients suspected of having renovascular hypertension, the primary mode of investigation should be renal DSA

[en] After incidentally observing a patient in whom abnormal uptake of gallium-67 citrate appeared to be explained by treatment with phenytoin, we have conducted a prospective study. Of sixteen persons with a seizure disorder treated with phenytoin, five (31 percent) had abnormal uptake of radiogallium either in the mediastinum, pulmonary hilum or both. Of nineteen historical control patients only one had such abnormal uptake. Phenytoin may thus cause the false-positive uptake of radiogallium in lymph nodes; this finding may also prove to have nosological importance in identifying patients at particular risk of the side-effects of this drug

[en] The early diagnostic management of patients with acute spinal canal trauma may be among the most difficult injuries referred to a trauma centre. No standardized protocol exists. Radiographic examinations commence with plain films, including special views. Further radiographic studies, if required, vary and include CT, myelography and conventional tomography. CT and metrizamide myelography are complementary. In more complicated fracture-dislocations, all of the above investigations may be necessary. Recent advances, including water-soluble contrast media, the lateral C1-2 puncture and CT, now offer faster, safer and more thorough follow-up investigations with less radiation exposure. Patients with multiple injuries, previously considered too severely injured to undergo further neurologic investigations, may now be more adequately assessed early in the acute phase of injury such that appropriate surgical decompression or stabilization may be performed. The maximum attainable neurologic improvement for such individuals may be better realized with the improved radio-diagnostic capabilities available

[en] The diagnostic usefulness of adrenal imaging with ¹³¹I-iodocholesterol (NP-59) is now well established. In order to correlate histopathology with the adrenal scan the authors examine and report their experience in 37 patients with surgically proven adrenal lesions or pituitary adenomas. This series included 24 patients with Cushing's syndrome: 14 caused by benign adrenal adenoma and 10 due to bilateral pituitary-ACTH-dependent adrenocortical hyperplasia. Ten patients with primary aldosteronism were submitted to surgery which confirmed the presence of aldosterone-producing adrenal adenomas. Two women with hyperandrogenism (due to virilizing ovarian tumors) had normal adrenals but the ovarian stromal luteoma markedly concentrated the iodocholesterol while the arrhenoblastoma did not. A patient with adrenal hematoma is also included in this report. The overall histopathological correlation with the radiocholesterol scintiscan yields an accuracy in our series of 97 percent (36/37). The false-negative adrenal scan (also missed by other non-invasive techniques) occurred in a patient with an aldosterone-producing adrenal adenoma measuring 1.0 x 1.5 cm

[en] The concepts of physical quantity and physical units of measurement are presented. The relations between quantities, the names and symbols for SI (International System) base units, derived units and special names of SI units are illustrated. From the definition of the radiation quantity dose equivalent, the SI unit for this quantity is shown to be dimensionally identical with the joule per kilogram. The sievert (Sv) is the special (restricted) name for the SI unit of the quantity dose equivalent, with 1 Sv=1 J/kg

[en] Digital subtraction arteriography (DSA) permits accurate, objective, and relatively pain-free evaluation of the morphology of angioplasty sites. During 1982, we performed DSA on 74 patients who had had 96 angioplasties over the previous three and one-half years. All of the DSA examinations were of diagnostic quality. We were surprised to find that 15 percent of angioplasty sites had undergone restenosis and, in addition, 12 percent of patients had new lesions. Because most of those patients were asymptomatic, such lesions would not have been detected by clinical assessment alone. Our angioplasty results compare favourably with other reported series. It is expected that DSA will play an increasingly important role in re-evaluation following treatment by angioplasty or surgery