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1.1. A case of herpes zoster with ileus simulating intestinal obstruction is presented in which barium enema studies demonstrated a constant, smooth constriction in the sigmoid colon which subsequently returned to normal. 2.2. The necessity for accurate evaluation of the roentgen changes in the barium enema studies is stressed. The possibility of intestinal involvement in herpes zoster should be kept in mind in order to obviate undesirable and unnecessary surgical intervention in such cases. 3.3. It is believed in our case that the pathologic changes in the sigmoid on barium enema study may have been due to direct involvement of the sigmoid by the herpes virus, since these changes cannot be satisfactorily accounted for on the basis of reflex segmental spasm.

W IDENING OF THE LINEAR THORACIC paraspinal shadow is generally attributed to inflammatory or malignant disease having its origin in the vertebral body, disc or paravertebral soft tissue structures. Among the more common conditions associated with changes in the paraspinal shadow, especially with a paravertebral mass, are tuberculous or pyogenic abscess, metastatic or primary malignant neoplasm, including myeloma and lymphoma, hemorrhage as a result of trauma, and others. Recently, abnormalities of the paraspinal shadow have been reported in cases of anemia with extramedullary hematopoiesis.3 Brailsford’ described a case in which rupture of the aorta simulated paravertebral abscess. Otherwise, we are not aware of any report mentioning changes in the paraspinal shadow as a result of dissecting aortic aneurysm. We suspect that with the lowered incidence of tuberculous paravertebral abscess, dissecting aortic aneurysm will prove to be one of the more common conditions producing changes in the paraspinal shadow, especially once the mainfestations of para-aortic hemorrhage and its relationship to dissecting aortic aneurysm are more generally appreciated.

Perforation of a necrotizing primary retroperitoneal neoplasm, resulting in a fistulous communication with the gastrointestinal tract, occurs rarely. To our knowledge, no cases radiographically docu-mented have been described. In his paper on primary retroperitoneal tumors, Donnelly (2) stated that neoplasms of this group are quite invasive and often become adherent to surrounding vital structures. In view of this circumstance and the great tendency to ischemic necrosis of these tumors, one might expect perforation into surrounding structures to occur more often than is generally recognized. The only direct reference to this complication was found in the Massachusetts General Hospital “Case Records” (1). In this case the diagnosis was established at autopsy. We have recently had the experience of studying two cases in which the diagnosis of excavating retroperitoneal neoplasm with fistulous communication into the gastrointestinal tract was suggested prior to surgery, on the basis of the radiologic examina...

Volvulus of the transverse colon constitutes one of the rarest forms of mechanical obstruction of the large bowel, and reliable radiologic documentation of such an accident occurring in a normally developed colon (excluding anomalies of rotation) is indeed unusual. Kallio (10), in 1932, collected 18 cases, including 2 from his own experience, and stated that, although uncommon, volvulus of this type was possible in the presence of an extremely redundant transverse colon whose flexures were in unusually close proximity; the torsion mechanism thus was similar to that occurring in the sigmoid. Kallio furnished an excellent review of the literature and the reader is referred to his paper for references to the earlier cases. The only subsequent contributions dealing with this condition are single case reports by Groth (8) in 1934, Melchior (13) in 1934, Martin and Ward (12) in 1944, Tabanelli (18) in 1947, Olivier and Libaude (15) in 1948, Murray (14) in 1950, and a report of 2 cases by Buenger (3) in 1954. Up...

In the last ten years efforts to increase the accuracy of diagnosis in the radiographic investigation of the upper gastrointestinal tract have centered on the use of image intensification devices, cinefluorography, and combinations of these technics, complemented by a television monitoring arrangement. It has been generally conceded that the routine utilization of such equipment will undoubtedly expedite upper gastrointestinal examination and will result in a greater accuracy of diagnosis. Our experiences indicate that, in spite of such improvements, many pathologic situations, including advanced forms of malignant growth, will continue to be overlooked unless high-kilovoltage technics are routinely utilized. High-kilovoltage technics have proved of immeasurable value in roentgenography of the lower gastrointestinal tract. Numerous observers (1–4, 10) have documented results which establish beyond doubt that the use of such procedures has made possible a simpler and more accurate examination which can be ...

Herniation of the stomach at the site of a transverse colostomy must be rare, for no reference pertinent to its occurrence could be found on a survey of the literature. The following case illustrates the problems encountered in the diagnosis of this entity and the difficulty of its differentiation from volvulus of the right colon. A 76-year-old white female was admitted on Feb. 8, 1952, in the early evening, with symptoms of abdominal pain, distention, progressive constipation, and weight loss. Blood had been noted in the stool on one occasion about a month previously. On physical examination loops of distended bowel were visible, bowel sounds were markedly reduced, and there was diffuse abdominal tenderness. Admission scout films of the abdomen indicated a low colonic obstruction, probably neoplastic, and two hours later a transverse colostomy over a glass rod was performed. The bowel was decompressed with a needle, but not opened until the following morning. At that time moderate amounts of gaseous, flu...

LIGATION of the hepatic artery or its branches has been a recognized complication of gallbladder and gastric surgery for years. Numerous authors have reported the physiologic and pathologic changes which follow this ligation, and recently Brittain et at. (1) published a comprehensive review of the subject, including a complete bibliography. Since we failed to find a radiographically documented case illustrating these alterations, and because experimental and clinical material indicates that the condition is reversible, provided proper treatment is instituted early in its course, we considered a case report justifiable. Case Report J. R., a 66-year-old white male, was admitted for elective cholecystectomy with a clinical and roent-genographic diagnosis of cholelithiasis. Physical examination was normal. The patient's only complaint was minimal right lower quadrant pain. On Feb. 14, 1957, a cholecystectomy without common duct exploration was performed, and a Penrose drain was placed in the foramen of Winslo...

1. Intramural jejunal hematomas may complicate anticoagulant therapy, mimicking the acute surgical abdomen.

Roentgenologic findings demonstrating sigmoidal fistula in a case of ovarian dermoid cyst and tubo-ovarian abscess are presented.

Practically all reports in the literature emphasize the frequency with which posterior dislocation of the shoulder is unrecognized clinically and roentgenographically. Most reports, however, do not discuss the associated fractures of the humeral head which are present in practically all cases of posterior dislocation. Identification of a fracture involving the medial portion of the humeral head is probably the most important roentgenographic clue to the diagnosis of a posterior dislocation, and yet such fractures are often unrecognized because in many instances their appearance is atypical or their importance is unappreciated and minimized. Identification of such a fracture must be considered presumptive evidence of a posterior dislocation and is an absolute indication for special studies in the axial projection. An unrecognized posterior dislocation, especially when associated with fracture, results in destruction of the humeral head and joint surface, and functional impairment of the shoulder girdle and...

Volvulus of the cecum and ascending colon is not as rare as is generally assumed. The early recognition of this type of colonic obstruction is of great importance for radiologist and surgeon alike. The radiologist can make the diagnosis correctly in many instances, and on this basis the surgeon is guided to proper remedial procedures and, eventually, to prevention of a recurrence of such an accident. Bundschuh (7) collected 110 cases of cecal volvulus in 1913. For the period 1913–42, Wolfer, Beaton, and Anson (63) collected 194 cases, bringing the total to 304. Courty (11) cites an additional 75 examples from France since 1940, and a review of the readily available sources in the American and British literature since 1942 has yielded 68 cases. To these we are adding 24 new cases, 19 of which were seen in a three-year interval, making a total of 471. Volvulus of the cecum and ascending colon represents a type of mechanical obstruction of the proximal half of the colon, presupposing inadequate fixation of a...

Roentgenographic recognition of carcinoma of the biliary ducts preoperatively is seldom possible. In the case to be reported here, a diagnosis of scirrhous neoplastic involvement of the entire common duct, as well as of the right and left hepatic ducts, was made following a percutaneous cholangiographic study. This diagnosis was substantiated at surgery, and a detailed roentgenographicpathologic correlation was possible as a result of autopsy study. The extent of involvement of the duct system, especially extension of the tumor into the porta hepatis, with involvement of the right and left hepatic ducts, permitted us to foresee failure of any contemplated surgical procedure for alleviation of the patient's jaundice. It is possible that, under different circumstances, one might be able to predict the type of operation necessary to carry out successfully a shunt procedure of the obstructed biliary duct system. Case History C. T., a 66-year-old white woman, was admitted March 28, 1957, with a persistent pain...

There is a prevailing concept that polypoid lesions of the colon are potentially malignant. Most radiologists rely on the double-contrast enema for the detection of colonic polyps. The new, simple, and most accurate method devised combines the use of large-field spotcompression radiography with high kilovoltage. The problem arising from this approach is no longer one of detection but rather the management of these lesions. A more conservative attitude toward very small, readily observable polyps seems justified.