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Merine D, Jones B, Ghahremani GG, Hamilton SR, Bayless TM. Hyperplasia of Brunner glands: the spectrum of its radiographic manifestations. Gastrointest Radiol 1991; 16:104-8. [PMID: 2016018 DOI: 10.1007/bf01887320] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Radiographic features of the duodenal mucosa were analyzed in a series of 26 patients in whom the diagnosis of Brunner gland hyperplasis (BGH) had been established by endoscopic biopsies. The observed mucosal patterns could be classified into five categories: (1) focal BGH causing a solitary submucosal adenoma or a cluster of sessile polyps in the otherwise smooth duodenal bulb surface (five cases); (2) diffuse BGH manifested by a myriad of small and uniform mucosal elevations (six cases); (3) multifocal BGH producing large and well-demarcated polygonal masses (six cases); (4) BGH with concomitant acute and/or chronic duodenitis showing marked thickening and nodularity of duodenal folds (four cases); or (5) BGH with predominant erosive duodenitis, leading to ulcerations (five cases). These radiographic findings showed a good correlation with the endoscopic and histopathologic manifestations of BGH and the frequently coexistent duodenitis.
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Affiliation(s)
- D Merine
- Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Merine D. Barium enemas in older patients. AJR Am J Roentgenol 1991; 157:197. [PMID: 2048523 DOI: 10.2214/ajr.157.1.2048523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Williams GM, Perler BA, Burdick JF, Osterman FA, Mitchell S, Merine D, Drenger B, Parker SD, Beattie C, Reitz BA. Angiographic localization of spinal cord blood supply and its relationship to postoperative paraplegia. J Vasc Surg 1991; 13:23-33; discussion 33-5. [PMID: 1987393 DOI: 10.1067/mva.1991.25611] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Forty-seven patients underwent selective catheterization of middle and lower thoracic intercostal and upper lumbar arteries to define the origin of the artery of Adamkiewicz. One patient had significant atheroembolism, and a second had transient lower extremity paresthesias. No other complications occurred. The origin was found in 26 (55%), and 21 patients underwent thoracoabdominal aneurysm repair with this knowledge. When the critical lumbar or intercostal artery could be included as part of a long proximal or distal anastomosis, all 12 patients could be included as part of a long proximal or distal anastomosis, all 12 patients survived, and one was paralyzed. However, if the aneurysm repair mandated a midgraft anastomosis to intercostal arteries critical to spinal cord perfusion, seven of nine patients either died or were paralyzed (p less than 0.05). In the group of 19 patients operated on in whom spinal cord blood supply was not identified three patients had a technically unsuccessful operation; two died, and one was paralyzed. Twelve of 16 patients who had an adequate, but unsuccessful attempt at localization were treated by intercostal "neglect" and survived. Late paresis developed in two patients, but they are walking now. One of the patients who died had multiple systems failure and awakened paraplegic. She had a patent, enlarged, thoracic radicular artery at T-5 which probably supplied to spinal cord and which was missed angiographically. Paralysis was associated with aneurysm extent (group 2 and III B, dissections vs group 1 & 3, p less than 0.05). Selective intercostal angiography requires further refinement, but it is safe and offers the promise of understanding the mechanisms and risks of spinal cord complications after repair of extensive thoracoabdominal aneurysms.
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Affiliation(s)
- G M Williams
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD
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Merine D, Takayasu K, Wakao F. Detection of hepatocellular carcinoma: comparison of CT during arterial portography with CT after intraarterial injection of iodized oil. Radiology 1990; 175:707-10. [PMID: 2160675 DOI: 10.1148/radiology.175.3.2160675] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Fourteen patients with hepatocellular carcinoma (HCC) were examined with computed tomography (CT) during arterial portography (CTAP) and with CT after intraarterial injection of iodized oil. The detectability of main lesions and associated daughter nodules or intrahepatic metastases was assessed. Hepatic resection was subsequently performed in all 14 patients. The results of the imaging studies were compared with the surgical and pathologic findings by means of a lesion-by-lesion analysis. A total of 34 masses were identified in the resected specimens: 18 main tumor masses and 16 intrahepatic metastases. For CTAP, the detection rate of main tumors was 94%; for iodized-oil CT, 82%. However, the daughter-nodule detection rates for both techniques were poor-only 38% detected for CTAP and 50% for iodized-oil CT. Although these two techniques remain important preoperative imaging methods in patients with HCC, the results of this study suggest that small daughter nodules (less than 5 mm in diameter) may go undetected with both techniques.
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Affiliation(s)
- D Merine
- Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD 21205
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Abstract
This is a report of a girl infant born with a protuberant abdomen and respiratory distress. A cystic mass was excised from the liver.
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Affiliation(s)
- D Merine
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD
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Merine D, Fishman EK. Hemangioendothelioma of bone: CT findings. J Comput Assist Tomogr 1989; 13:1098-100. [PMID: 2584500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- D Merine
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21205
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Affiliation(s)
- D Merine
- Johns Hopkins Hospital, Baltimore, Maryland
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Abstract
The sonographic findings in a patient with typhlitis are presented. Sonography showed a solid mass with a "target" sign in the right lower quadrant, continuous with the ascending colon. In addition to suggesting the diagnosis, sonography was helpful in the follow-up examination of the patient because it was able to assess the gradual decrease in the thickness of the bowel wall and ultimate resolution of the inflammatory process.
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Affiliation(s)
- D Merine
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21205
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Merine D, Fishman EK, Rosengard A, Tolo V. Chondromyxoid fibroma of the fibula. J Pediatr Orthop 1989; 9:468-71. [PMID: 2732329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A 3 1/2-year-old girl presented with a lytic lesion in the diametaphyseal region of the right fibula. In addition to plain roentgenography, radiological evaluation consisted of bone scintigraphy and computed tomography. The radiological features suggested a benign lesion. Pathological examination revealed a chondromyxoid fibroma.
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Affiliation(s)
- D Merine
- Departments of Radiology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205
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Merine D, Fishman EK, Jones B. CT of the small bowel and mesentery. Radiol Clin North Am 1989; 27:707-15. [PMID: 2657849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The detection and definition of small bowel pathology is a frequent clinical and radiologic problem. Although contrast radiography and enteroclysis are the primary means of evaluating the small bowel, computed tomography (CT) has become increasingly important as a complementary examination. Initial diagnoses proffered by barium studies may be further characterized by CT and this additional information may have significant impact on patient management.
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Affiliation(s)
- D Merine
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Abstract
Although well defined pathologically, alveolar cell carcinoma can be difficult to diagnose because of its many clinical presentations. In a retrospective study of 45 cases, we reviewed the radiologic, pathologic, and clinical features of this neoplasm. Forty-one patients had a single peripheral mass that measured between 8 mm and 7 cm. Three patients had multiple nodules, and one had diffuse involvement of the right lung. Other prominent radiologic features included air bronchograms in eight cases, a "tail sign" in ten cases, and universal absence of calcifications. Pathologic examination showed an associated scar in 12 patients. There was a relatively high frequency (16%) of metachronous malignancies, including two osteosarcomas, three basal cell carcinomas, and one case each of chronic lymphocytic leukemia and thymoma. All but one of the associated tumors were diagnosed six months to two years before the diagnosis of alveolar cell carcinoma.
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Affiliation(s)
- D Merine
- Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Md 21205
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Abstract
A case of perirenal hematoma following nephrostomy tube removal is presented. Computed tomography was useful in defining the extent of the hematoma. The patient was managed conservatively with eventual resolution of the hematoma.
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Affiliation(s)
- D Merine
- Russell H. Morgan Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Lammert GK, Merine D, White RI, Fishman EK, Porterfield JK. Embolotherapy of a high-flow false aneurysm by using an occlusion balloon, thrombin, steel coils, and a detachable balloon. AJR Am J Roentgenol 1989; 152:382-4. [PMID: 2783516 DOI: 10.2214/ajr.152.2.382] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- G K Lammert
- Russell H. Morgan Department of Radiology & Radiologic Sciences, Johns Hopkins Medical Institutions, Baltimore, MD 21205-2191
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Abstract
Visualization of portal venous air in adults is usually an ominous sign of impending death. The case reported below demonstrates portal vein gas with a benign course in a patient with a duodenal perforation following endoscopic retrograde cholangiopancreatography.
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Affiliation(s)
- D Merine
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD
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Abstract
A retrospective review of 275 consecutive patients with symptomatic Crohn disease to determine the frequency and type of bladder involvement yielded 14 cases. All 14 patients had a long standing history of Crohn disease with other positive radiologic features at the time of detection of bladder involvement. Patients were categorized into two groups based on the CT findings: Group I (n = 4) had focal bladder wall thickening adjacent to an extravesical soft tissue mass and/or focal bowel wall thickening; Group II (n = 10) had fistula formation with intravesical air with associated focal bowel wall thickening and/or extravesical soft tissue mass. Bladder involvement in Crohn disease is a progressive pathological process that can result in formation of an enterovesical fistula. The patient may come to radiologic attention at any stage in the course of the disease. Computed tomography is a sensitive and noninvasive method of evaluating the bladder and can be used to identify patients in the prodromal stage who are at risk of developing enterovesical fistulae. Timely intervention may prevent frank perforation into the lumen of the bladder by an inflammatory mass.
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Affiliation(s)
- D Merine
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD
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Merine D, Fishman EK, Sitzmann JV, Kuhlman JE, Order S, Pessar M, Zerhouni EA. Vascular abnormalities following radio- and chemotherapy of hepatic neoplasms: CT angiographic findings. J Comput Assist Tomogr 1988; 12:584-7. [PMID: 2839560 DOI: 10.1097/00004728-198807000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Four patients (three with hepatocellular carcinoma and one with colorectal carcinoma metastatic to the liver) previously treated with chemotherapy or radiotherapy or both in an attempt to reduce tumor bulk prior to surgical resection were examined by CT angiography (CTA). Areas of abnormal enhancement and irregular vessels simulating tumor involvement proved to be free of neoplasm at surgery. Perfusion abnormalities and vascular irregularity on CTA following radiotherapy or chemotherapy should not be automatically considered as neoplastic. Tissue confirmation in such cases should be obtained to rule out treatment related hepatic parenchymal changes.
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Affiliation(s)
- D Merine
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD
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Abstract
Mediastinal adenopathy and endobronchial metastases are sometimes the only radiological manifestation of metastatic disease from extrathoracic neoplasms. We report on four patients in whom hilar and paratracheal adenopathy (n = 3) and endobrochial involvement (n = 1) were the only intrathoracic manifestations of metastatic renal cell carcinoma. Three of the patients had nephrectomies 9 months to 4 years before the appearance of intrathoracic disease; another patient presented with medastinal disease as the initial manifestation of renal cell carcinoma. If a patient with a history of renal cell carcinoma develops pulmonary hilar adenopathy, metastatic disease should be suspected and appropriate diagnostic measures should be taken.
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Affiliation(s)
- D Merine
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Abstract
The clinical records and radiologic findings in six patients with spontaneous (nontraumatic) intrahepatic and subcapsular hemorrhage were reviewed. Four patients had underlying liver lesions (hepatocellular carcinoma and metastasis from B-cell lymphoma in one patient each and hepatic adenoma in two other patients). One patient had intrahepatic hemorrhage associated with hepatic necrosis secondary to organophosphate toxicity. The specific etiology of hemorrhage in the remaining patient proved elusive despite an exhaustive search. Hepatic hemorrhage was diagnosed and followed by CT (six cases), sonography (two cases), and celiac arteriography (three cases). Computed tomography was useful in defining the extent of the hematoma and showing density changes related to the age of the hematoma.
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Affiliation(s)
- D Merine
- Russell H. Morgan Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD 21205
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Abstract
In three patients the diagnosis of sacral osteomyelitis was made when CT demonstrated intraosseous (two) and intraforaminal (one) gas. Two of the three patients also had radionuclide bone scans, one of which was unremarkable. In the other case, radionuclide scintigraphy greatly underestimated the extent of the disease process when compared with CT. All three patients had contiguous pelvic abscesses as a cause of the osteomyelitis. Although there was a high clinical suspicion for an intraabdominal process, the diagnosis of superimposed osteomyelitis of the sacrum was unsuspected. The detection of intraosseous gas is a pathognomonic, albeit uncommon, manifestation of osteomyelitis. Although the radionuclide bone scan is the method of choice for detecting osteomyelitis, CT should be used as a complementary study in certain patients.
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Affiliation(s)
- D Merine
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD
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Abstract
The CT findings in five patients with pseudomembranous colitis are presented. The findings consisted of varying degrees of bowel wall and haustral fold thickening. Ascites was noted in three patients. Clinically and radiologically, pseudomembranous colitis can be confused with other inflammatory disorders of the gastrointestinal tract. Although the CT findings were not pathognomonic, they were highly suggestive of pseudomembranous colitis when combined with the clinical information.
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Affiliation(s)
- D Merine
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21205
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Merine D, Fishman EK, Siegelman SS. Renal xanthogranulomatosis: radiological, clinical, and pathological features in two cases. J Comput Assist Tomogr 1987; 11:785-9. [PMID: 3655040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Xanthogranulomatosis is a multicentric or systemic proliferative disorder of histiocytes. Two cases of xanthogranulomas are reported, each involving the kidneys. One patient also had concomitant orbital and CNS involvement. Primary renal involvement without associated retroperitoneal masses is an uncommon manifestation of this disorder. The CT appearance of renal involvement in both patients was distinctive and remarkably similar. Both patients had bilaterally enlarged kidneys in which the renal sinus fat was replaced by a fibrotic process that caused mild calicectasis. The clinical and roentgenographic features of xanthogranulomatosis bear a close resemblance to those seen in two fibrosclerosing syndromes: sinus histiocytosis with massive lymphadenopathy and retroperitoneal fibrosis.
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Affiliation(s)
- D Merine
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21205
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Abstract
Two patients with acute transverse myelitis were evaluated by both CT myelography and magnetic resonance. Computed tomographic myelography showed fusiform cord enlargement involving several levels; one patient had a subtotal block in the thoracic spine. Magnetic resonance displayed similar findings of cord enlargement. The demonstration of cord swelling in acute transverse myelitis is an uncommon radiologic manifestation of the disease.
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Abstract
The CT scans in nine proven cases of enteroenteric intussusception were analyzed. Three different CT patterns were observed: a target lesion (n = 5), a reniform mass (n = 2), and a sausage-shaped mass with alternating layers of low and high attenuation (n = 2). Small-bowel series were available within 2-4 days of CT in eight patients and were positive in five. Surgical proof of intussusception was available in seven of the nine patients. Resected small-bowel specimens from patients with the reniform configuration revealed focal ischemic changes. Other objective parameters of ischemia such as acidosis and hyperamylasemia were also present in the two patients with reniform masses. Such changes were not evident in the other patients. This suggests that intussusceptions with reniform configurations warrant more urgent surgical attention. The varying patterns of intussusception on CT should be recognized so that appropriate management can be initiated.
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