Downloaded from www.ajronline.org by 41.190.199.184 on 10/30/15 from IP address 41.190.199.184. Copyright ARRS. For personal use only; all rights reserved
Letters
Radiography
of Fast-Food
Stomach
Furosemide-Augmented
We recently became aware of an unusual appearance of the stomachs of some of our scoliosis clinic patients. These were frequently distended with frothy appearing material, and we initially wondered if this indicated some type of diminished motility related to the use of bracing devices. It finally became apparent that our observation was the result of an early
afternoon
clinic
in a hospital
with
its own
In their raphy
article
Talner
fact,
fast-food
on
thatthis
measurement
does
not exactly
view
of
the
intravenous
radiographic renal of
This
surface
the concomitant geometry
is not
test
is, in
variations,
volume
the
urog-
method
hypertension.
of
explain
particular
nonsignificant
restaurant. Patients would present themselves to the mainlobby radiographic suite and, if a 10 or 15 mm wait were anticipated, run across the hall for a quick lunch. Figure 1A
[1] claim
test of renovascular
based
Urography
on furosemide-augmented
et al.
a satisfactory
Intravenous
kidney.
which
variation,
in
However,
these
in surface observed by Tamer et al. to important variations in volume, in view kidney, which might be called a prolate
variations
probably correspond of the shape of the spheroid. Under
these
v
formula:
large
axis
This
conditions,
formula
axis,
or
the
renal
4/3 ab2, where and half the small bears
width
witness
of the
volume
to the
kidney
great
at the
importance
hile,
since
used to the second power. This formula [3] in renal scintigraphy for calculating hippuran
volume.
My colleagues
Therefore,
I believe
kidneys
that
are
often
volume
provides
show
normal
or induced
that
by
a useful
per
unit
different
difficulties
both
and pathologic (measurement
deformed
renal
is
at my institution
an extraction I find
small
parameter
of
extrac-
to identical extractions proves the primordial role of volume.
despite
of the normal and experimental
by the
of the
this
is used
and
tions per surface unit can correspond per volume unit and vice versa; this of the width of the kidney in variation (assimilation spheroid)
is calculated
a and b are, respectively. half the axis of the prolate spheroid [2].
=
diseases), parameter
functional
surface parameter. The renal volume as reference in renal physiopathology.
theoretical
kidney to a prolate of the axes when the
calculation
whose
variation
variations
better
parameter
can
of can
than also
Michel
HOpital
the serve
Collard
Ed. Herriot 69374 Lyon France
REFERENCES
shows a radiograph made cheeseburger, a small order For
burger The
confirmation
of our
and a carbonated
resulting
mush
was
1 . Talner
15 mm after ingestion of a large of fries, and a vanilla shake. hypothesis,
beverage poured
into
a quarter-pound
were mixed a plastic
essential
hamwhich
2. Kartz
was
1979
© 1979 American
Roentgen
Ray Society
of
method
Coel
Blantz
Lyonnett tion
AJR Rector
AC, blood
Am J Physiol
M,
Guey
tubulaire
130
SB.
Emarine
urography: :257-260,
CW:
results
in
1978
FC Jr. Seldin
flow.
DW:
I. Analysis
Claveyrolas
A:
Effet
P.
dune
r#{233}nale mesur#{233}e .
Levy
of
Measure-
microsphere
220 : 1 903-1 91 3, 1971
A.
D, Pinet
l’hippuran
MN,
intravenous
intrarenal .
3. Collard
J Radiol
Electrol
Mendoza
M.
arteriographie
a
l’aide
de
: 23-28,
59
Traeger sur
J,
Ia fonc-
a
Ia scintigraphie
1978
Reply Dr. volume
Collard
renal fraught
321
correctly
is better
interested semide
Children’s Hospital of Philadelphia Philadelphia , Pennsylvania 19104 February
RA,
hypertension.
MA,
ment
in turn placed in a plastic pan containing a small amount of water to mimic surrounding soft tissues. A radiograph of this experimental preparation (fig. 1 B) provided a remarkably good match for the stomach contents seen in our clinic patients. We offer this experience as a radiologic challenge which was fun to solve and as a curiosity which may amuse or interest the readers of our letter. The soft consistency of the meal and the rapidity with which fast foods are often ingested no doubt contribute to their appearance. Thomas J. Spackman Suzanne E. Betsch
AJR 132:321-322,
Stone
Furosemide-augmented
in the blender. basin
LB,
in injection. volume with
than
points
size
renal
measurement
from
I am to
both
that
estimation
of
renal
area when one is a stimulus such as furo-
of surface
changes
However. dangers,
out
measurement
afraid
that
intravenous
theoretical
the
application
urography and
practical,
0361-803X/79/1
322-0321
of is
so
that
it
$0.00
322
LETTERS
would
not be productive.
Collard’s
statement
the width
of the kidney
Not the least of the problems
about
the
short
measured
axis
from
of
the
the hilar
AJR:132,
February
1979
is Dr.
kidney,
that
surface
to the
is
lateral margin. As we indicated in our article, this measurement is done by drawing a medial tangent line, which itself introduces
Downloaded from www.ajronline.org by 41.190.199.184 on 10/30/15 from IP address 41.190.199.184. Copyright ARRS. For personal use only; all rights reserved
inaccuracy.
Nevertheless,
these urograms. believe
the
Our
main
showed
it is the
When that
calculated point
error
volume
was
that
best we can is compounded
would
patients
such a wide variation
do on many by squaring,
be untrustworthy with
essential
of I
at best. hypertension
in renal area change
that it was
not likely to be useful in culling out those patients with renal artery stenosis. I see nothing in Dr. Collard’s letter to indicate that this aspect of the problem would be obviated by attempting to measure volume changes. Lee
Fig. 1
B. Talner
vessels
University Hospital University of California, San Diego San Diego, California 92103
Systemic
Air Embolism Enterocolitis
I have recently seen and pneumoperitoneum
veins. vessels
in Necrotizing
a neonate with with portal
necrotizing enterocolitis venous gas who, in
a
premortem film, showed gas in the femoral vessels. Previously, I thought this might justify a case report; however, since an article in September 1978 AJR, a letter seemed more appropriate. In a recent
article,
Kogutt
[1] states
is a documented
complication
and
While
its treatment.
that systemic
of hyaline
the
mechanism
air embolus
membrane
disease
for intravascular
air is
not well understood, it is attributed to a pressure phenomenon with dissection of air into pulmonary veins and from there into the systemic circulation. As stated, systemic air embolism can also be seen in other clinical situations as ‘following surgical procedures, trauma, in submarine personnel and in asthmat‘
ics.’
‘
To this
A 20-day-old birth
for
list,
I would
premature
prematurity
and
like
to add
male sepsis.
necrotizing
infant The
enterocolitis.
was hospitalized child
had
done
(probably The
chest
nor
the
veins) was
bilaterally
normal
heart.
and
The
(arrows) gas
infant
was
and not
died
also
in portal
observed
and
in other
permission
for
autopsy was refused. The etiology of systemic air embolism in the chest is somewhat obscure, but generally felt to be related to alveolar rupture and dissection of air into the perivascular spaces. Air embolism is probably secondary to air-block phenomenon with interstitial air, pneumothorax, pneumomediastinum ‘ or pneumopericardium usually present. In short, air under pressure and outside of its normal spaces must be present for systemic air embolism.
Such a condition exists necrotizing enterocolitis. under tension of dissecting
in pneumoperitoneum secondary to There is a large collection of free air
in the peritoneal along the vascular
cavity which should be capable sheaths and into the systemic
circulation. While I suspect cannot be certain.
that the air in this case is probably The amount of pressure necessary
venous, I to over-
come venous pressure would be somewhat less than arterial and air should preferentially fill the venous system. The caliber of the
air
column
the collapsed
of the
arteries
vessels
one
in this
would
expect
case
seems
to find
larger
than
in a neonate
in
extremis.
since
Theodore
well
clinically and was expected to be discharged soon. The infant had never shown clinical or radiographic evidence of hyaline membrane disease and had never been placed on a respirator. At 20 days of life, abdominal distension and bloody diarrhea were noted. A plain film of the abdomen showed marked distension of multiple bowel loops and portal venous gas. A film 4 hr later showed a large pneumoperitoneum and extensive pneumatosis intestinalis (fig. 1). Air was present in femoral
Martin
Miller
Luther King, Jr. General Hospital Los Angeles, California 90059
REFERENCE 1
.
Kogutt
MS: Systemic
air embolism
therapy in the neonate: AJR 131 :425-429, 1978
six
cases
secondary including
to respiratory one
survivor.
Letters
Radiography
of Fast-Food
Stomach
Furosemide-Augmented
We recently became aware of an unusual appearance of the stomachs of some of our scoliosis clinic patients. These were frequently distended with frothy appearing material, and we initially wondered if this indicated some type of diminished motility related to the use of bracing devices. It finally became apparent that our observation was the result of an early
afternoon
clinic
in a hospital
with
its own
In their raphy
article
Talner
fact,
fast-food
on
thatthis
measurement
does
not exactly
view
of
the
intravenous
radiographic renal of
This
surface
the concomitant geometry
is not
test
is, in
variations,
volume
the
urog-
method
hypertension.
of
explain
particular
nonsignificant
restaurant. Patients would present themselves to the mainlobby radiographic suite and, if a 10 or 15 mm wait were anticipated, run across the hall for a quick lunch. Figure 1A
[1] claim
test of renovascular
based
Urography
on furosemide-augmented
et al.
a satisfactory
Intravenous
kidney.
which
variation,
in
However,
these
in surface observed by Tamer et al. to important variations in volume, in view kidney, which might be called a prolate
variations
probably correspond of the shape of the spheroid. Under
these
v
formula:
large
axis
This
conditions,
formula
axis,
or
the
renal
4/3 ab2, where and half the small bears
width
witness
of the
volume
to the
kidney
great
at the
importance
hile,
since
used to the second power. This formula [3] in renal scintigraphy for calculating hippuran
volume.
My colleagues
Therefore,
I believe
kidneys
that
are
often
volume
provides
show
normal
or induced
that
by
a useful
per
unit
different
difficulties
both
and pathologic (measurement
deformed
renal
is
at my institution
an extraction I find
small
parameter
of
extrac-
to identical extractions proves the primordial role of volume.
despite
of the normal and experimental
by the
of the
this
is used
and
tions per surface unit can correspond per volume unit and vice versa; this of the width of the kidney in variation (assimilation spheroid)
is calculated
a and b are, respectively. half the axis of the prolate spheroid [2].
=
diseases), parameter
functional
surface parameter. The renal volume as reference in renal physiopathology.
theoretical
kidney to a prolate of the axes when the
calculation
whose
variation
variations
better
parameter
can
of can
than also
Michel
HOpital
the serve
Collard
Ed. Herriot 69374 Lyon France
REFERENCES
shows a radiograph made cheeseburger, a small order For
burger The
confirmation
of our
and a carbonated
resulting
mush
was
1 . Talner
15 mm after ingestion of a large of fries, and a vanilla shake. hypothesis,
beverage poured
into
a quarter-pound
were mixed a plastic
essential
hamwhich
2. Kartz
was
1979
© 1979 American
Roentgen
Ray Society
of
method
Coel
Blantz
Lyonnett tion
AJR Rector
AC, blood
Am J Physiol
M,
Guey
tubulaire
130
SB.
Emarine
urography: :257-260,
CW:
results
in
1978
FC Jr. Seldin
flow.
DW:
I. Analysis
Claveyrolas
A:
Effet
P.
dune
r#{233}nale mesur#{233}e .
Levy
of
Measure-
microsphere
220 : 1 903-1 91 3, 1971
A.
D, Pinet
l’hippuran
MN,
intravenous
intrarenal .
3. Collard
J Radiol
Electrol
Mendoza
M.
arteriographie
a
l’aide
de
: 23-28,
59
Traeger sur
J,
Ia fonc-
a
Ia scintigraphie
1978
Reply Dr. volume
Collard
renal fraught
321
correctly
is better
interested semide
Children’s Hospital of Philadelphia Philadelphia , Pennsylvania 19104 February
RA,
hypertension.
MA,
ment
in turn placed in a plastic pan containing a small amount of water to mimic surrounding soft tissues. A radiograph of this experimental preparation (fig. 1 B) provided a remarkably good match for the stomach contents seen in our clinic patients. We offer this experience as a radiologic challenge which was fun to solve and as a curiosity which may amuse or interest the readers of our letter. The soft consistency of the meal and the rapidity with which fast foods are often ingested no doubt contribute to their appearance. Thomas J. Spackman Suzanne E. Betsch
AJR 132:321-322,
Stone
Furosemide-augmented
in the blender. basin
LB,
in injection. volume with
than
points
size
renal
measurement
from
I am to
both
that
estimation
of
renal
area when one is a stimulus such as furo-
of surface
changes
However. dangers,
out
measurement
afraid
that
intravenous
theoretical
the
application
urography and
practical,
0361-803X/79/1
322-0321
of is
so
that
it
$0.00
322
LETTERS
would
not be productive.
Collard’s
statement
the width
of the kidney
Not the least of the problems
about
the
short
measured
axis
from
of
the
the hilar
AJR:132,
February
1979
is Dr.
kidney,
that
surface
to the
is
lateral margin. As we indicated in our article, this measurement is done by drawing a medial tangent line, which itself introduces
Downloaded from www.ajronline.org by 41.190.199.184 on 10/30/15 from IP address 41.190.199.184. Copyright ARRS. For personal use only; all rights reserved
inaccuracy.
Nevertheless,
these urograms. believe
the
Our
main
showed
it is the
When that
calculated point
error
volume
was
that
best we can is compounded
would
patients
such a wide variation
do on many by squaring,
be untrustworthy with
essential
of I
at best. hypertension
in renal area change
that it was
not likely to be useful in culling out those patients with renal artery stenosis. I see nothing in Dr. Collard’s letter to indicate that this aspect of the problem would be obviated by attempting to measure volume changes. Lee
Fig. 1
B. Talner
vessels
University Hospital University of California, San Diego San Diego, California 92103
Systemic
Air Embolism Enterocolitis
I have recently seen and pneumoperitoneum
veins. vessels
in Necrotizing
a neonate with with portal
necrotizing enterocolitis venous gas who, in
a
premortem film, showed gas in the femoral vessels. Previously, I thought this might justify a case report; however, since an article in September 1978 AJR, a letter seemed more appropriate. In a recent
article,
Kogutt
[1] states
is a documented
complication
and
While
its treatment.
that systemic
of hyaline
the
mechanism
air embolus
membrane
disease
for intravascular
air is
not well understood, it is attributed to a pressure phenomenon with dissection of air into pulmonary veins and from there into the systemic circulation. As stated, systemic air embolism can also be seen in other clinical situations as ‘following surgical procedures, trauma, in submarine personnel and in asthmat‘
ics.’
‘
To this
A 20-day-old birth
for
list,
I would
premature
prematurity
and
like
to add
male sepsis.
necrotizing
infant The
enterocolitis.
was hospitalized child
had
done
(probably The
chest
nor
the
veins) was
bilaterally
normal
heart.
and
The
(arrows) gas
infant
was
and not
died
also
in portal
observed
and
in other
permission
for
autopsy was refused. The etiology of systemic air embolism in the chest is somewhat obscure, but generally felt to be related to alveolar rupture and dissection of air into the perivascular spaces. Air embolism is probably secondary to air-block phenomenon with interstitial air, pneumothorax, pneumomediastinum ‘ or pneumopericardium usually present. In short, air under pressure and outside of its normal spaces must be present for systemic air embolism.
Such a condition exists necrotizing enterocolitis. under tension of dissecting
in pneumoperitoneum secondary to There is a large collection of free air
in the peritoneal along the vascular
cavity which should be capable sheaths and into the systemic
circulation. While I suspect cannot be certain.
that the air in this case is probably The amount of pressure necessary
venous, I to over-
come venous pressure would be somewhat less than arterial and air should preferentially fill the venous system. The caliber of the
air
column
the collapsed
of the
arteries
vessels
one
in this
would
expect
case
seems
to find
larger
than
in a neonate
in
extremis.
since
Theodore
well
clinically and was expected to be discharged soon. The infant had never shown clinical or radiographic evidence of hyaline membrane disease and had never been placed on a respirator. At 20 days of life, abdominal distension and bloody diarrhea were noted. A plain film of the abdomen showed marked distension of multiple bowel loops and portal venous gas. A film 4 hr later showed a large pneumoperitoneum and extensive pneumatosis intestinalis (fig. 1). Air was present in femoral
Martin
Miller
Luther King, Jr. General Hospital Los Angeles, California 90059
REFERENCE 1
.
Kogutt
MS: Systemic
air embolism
therapy in the neonate: AJR 131 :425-429, 1978
six
cases
secondary including
to respiratory one
survivor.
