Letters Grading
.
to the of Splenic
Editor
Trauma
I agree with Murray and McLellan that ectasia is preferable to lymphangiomatosis
From:
Weill, MD Department of Radiology, Hopital Avenue Fleming, 25030 Besancon F.
Jean Minjoz Cedex, France
Editor: I read with interest the controversial articles by Drs Raptopouand Fink (1) and Drs Umlas and Cronan (2) regarding cornputed tomographic (CT) grading of splenic trauma, which appeared in the August 1991 issue of Radiology. I know a very simple way to bring both groups of authors to an agreement. This is to skip CT as the primary procedure in los
splenic trauma and turn perficiat. High-resolution small
to ultrasound US yields
The
spleen
is su-
regard-
abnormalities hematomas as precisely as CT, but its definite advantage is to enable follow-up of the patient every 6, 12, or 24 hours, according to the clinical data. Two, three, four and sometimes more consecutive examinations wilt show hematomas developing in spleens that were apparently absolutely normal at admittance and will enable one to monitor the hemopentoneum, if present. A systematic last examination of apparently normal spleens after 7 days will sometimes show one of those lifethreatening, late-appearing subcapsular hematomas. Obviously, due to irradiation and injection of contrast media, CT cannot be repeated as often. Dynamic, repeated US renders useless initial grading. In our institution, CT is used only as a complement in selected cases. Most of our patients with splenic trauma are treated without undergoing even one CT examinaing
parenchymal
(US).
morphologic data and supcapsular
the
term
lymphangi-
to describe this entity, and my colleagues and I adopted this in a more recent publication (5). However, it is preferable to describe the condition as “renal lymphangiectasia” and to exclude the term “peripelvic” from the nomenclature, since, as the authors’ case and previously published cases show, the lymphatic cysts are not confined to the renal sinus but also occur in the perinephnc tissues and central retroperitoneum. Indeed, my colleagues and I (2) and Blumhagen et at (3) have shown that this condition may also be associated with diffuse intrarenal lymphangiectasia, which may cause nephromegaty and markedly increased renal echogenicity on sonograms. I agree with Murray and McLetlan that many renal sinus or penpelvic cysts discov-
ered incidentally
at CT probably
represent
a minor
variant
of
this condition. The condition is probably caused by a developmental obstruction of the regional lymphatic drainage.
References 1.
Murray pearance
2.
3.
4. 5.
KK, McLellan
Renal
peripelvic
lymphangiectasia:
ap-
1991; 180:455-456.
Meredith WT, Levine E, Ahlstrom NC, Crantham JJ. Exacerbation of familial renal lymphangiomatosis during pregnancy. AJR 1988; 151:965-966. Blumhagen JD, Wood BJ, Rosenbaum DM. Sonographic evaluation of abdominal lymphangiomas in children. J Ultrasound Med 1987; 6:487-495. Gorman CJ, ed. RSNA index to imaging literature. Oak Brook, Ill: Radiological Society of North America, 1990. Levine E, Grantham JJ. Radiology of cystic kidneys. In: Gardner
KD, Bernstein lands:
tion.
CL.
at CT. Radiology
J, eds. The cystic kidney.
Kluwer,
1990;
Dordrecht,
The Nether-
171-206.
References I.
Raptopoulos V, Fink MP. CT grading how the same statistics can be interpreted 1991; 180:309-310. Umlas SL, Cronan JJ. Reply. Radiology
2.
of splenic trauma in adults: differently. Radiology U 1991;
180:310-311.
Brain
P-31
MR
Death in the Spectroscopy
Neonate:
Assessment
with
From:
Renal
Lymphangiectasia
Errol Levine, Department
MD, PhD of Diagnostic
.
Michael R. Terk, MD,* Joel R. Gober, PhD,* Christopher DeGiorgio, MD,5 Paul Wu, MD,t and Patrick M. Colletti, Departments of Radiology,* Neurology,t and Neonatology,t University of Southern California School of Medicine 1200 North State Street, Los Angeles, CA 90033
From:
Medical 39th
Radiology,
University
Editor:
of Kansas
We read with great interest the article by Kato et at (1) in the April 1991 issue of Radiology. In their article, they used phosphorus-31 in vivo magnetic resonance (MR) spectroscopy to
Center
Street
and Rainbow
Boulevard,
Kansas
City,
KS 66103
Editor: I read
the by
evaluate
with August
their
interest the article by Murray and McLellan (1) in 1991 issue of Radiology. However, I was surprised
assertion
that
neither
the
appearance of renal lymphangiectasia retroperitoneal perivascular lymphatic
computed
tomographic nor its association cysts has been
(CT) with previ-
described in the radiology literature. My colleagues and I and others have previously reported the CT findings in this condition (2,3), although we originally used the term “renal lymphangiomatosis” to describe it. The association with central retroperitoneal cysts related to the aorta and inferior vena cava has also been described (3). Both articles are listed in the RSNA Index to Imaging Literature (4). ously
582
MD*
brain
death
occasion to perform 40 weeks gestational
in children. Since such an assessment
that time, we have had on a newborn at about
age.
The term newborn studied was delivered because of a motor vehicle accident that resulted in rupture of the maternal uterus. At laparotomy, the newborn was found floating in the maternal abdomen. The Apgar score was 0 immediately after birth, 1 at 20 minutes, and 3 at 25 minutes. The newborn lacked evidence of cerebral and brain stem activity and had absent pupitlary, corneal, and ocutocephalic reflexes as well as spontaneous respirations. The newborn did poorly, and results of two electroencephalographic
days after
delivery
examinations
showed
etectrocerebral
performed
silence;
12 and
16
the new-