Search

Giant congenital melanocytic nevus (GCMN) is a rare birthmark disorder that reportedly affects 1 in 20,000–500,000 live births. Here, we present a case of GCMN in a 1-day-old newborn that covered the entire abdomen, reaching the thigh and chest, and laterally toward the backward aspect of the trunk to involve the entire back and buttocks. We discuss the diagnostic and treatment approach.

PURPOSE: To develop a quantitative DCE MRI technique enabling entire-abdomen coverage, free-breathing acquisition, 1-second temporal resolution, and T(1)-based quantification of contrast agent concentration and kinetic modeling for the characterization of pancreatic ductal adenocarcinoma (PDAC). METHODS: Segmented FLASH readouts following saturation-recovery preparation with randomized 3D Cartesian undersampling was used for incoherent data acquisition. MR Multitasking was used to reconstruct 6-dimensional images with 3 spatial dimensions, 1 T(1) recovery dimension for dynamic T(1) quantification, 1 respiratory dimension to resolve respiratory motion, and 1 DCE time dimension to capture the contrast kinetics. Sixteen healthy subjects and 14 patients with pathologically confirmed PDAC were recruited for the in vivo studies, and kinetic parameters v(p), K(trans), v(e), and K(ep) were evaluated for each subject. Intersession repeatability of Multitasking DCE was assessed in 8 repeat healthy subjects. One-way unbalanced analysis of variance (ANOVA) was performed between control and patient groups. RESULTS: In vivo studies demonstrated that v(p), K(trans), and K(ep) of PDAC were significantly lower compared with nontumoral regions in the patient group (P = .002,.003, .004, respectively) and normal pancreas in the control group (P = .011

Intraoperative grid pattern markings have been used in the performance of liposuction. Grid pattern markings include series of longitudinal and transverse lines to delineate various anatomical boundaries and landmarks, including the midline, lateral line, and medial line. The markings are superimposed on the customary preoperative markings and divide broad or circumferential body surfaces into smaller subunits for liposuction. Grid pattern markings are applied to areas such as the anterior thighs, medial thighs, entire abdomen, flanks, back, arms, buttocks, calves, and ankles; they are not applied to smaller, less curved areas. Eighty-two consecutive patients underwent lipoplasty in 562 areas of the body. The revision rate for postliposuction contour irregularities was 4.0 percent (nine of 224 areas) where grid pattern markings were used; one area had an indentation type of contour irregularity and required autologous fat grafting. The revision rate was 1.5 percent (five of 328 areas) where grid pattern markings were not used; two areas in one patient had indentation-type contour irregularities and required autologous fat grafting. All remaining areas requiring revision had protuberant-type contour irregularities and responded to additional liposuction only. The use of grid pattern markings is associated with a low incidence of serious contour-related complications.

We report a method of fast adipose tissue (FAT) assessment to characterize the quantity, and distribution of abdominal adipose tissue. Whole-volume coverage of the abdomen was obtained using 31 contiguous transverse T(1)-weighted images from 16 obese females. A radiologist manually traced all adipose tissue volumes in the images, while a physiologist used an automated method to measure adipose tissue in a single image at the level of the umbilicus. Automated analysis of the umbilicus-level image was significantly correlated with values obtained by manual analysis of the entire abdomen (p < 0. 001). There was good agreement between the automated umbilicus-level image method and the manual whole abdomen method for subcutaneous adipose tissue (r(2) = 0.958), visceral adipose tissue (r(2) = 0. 753), and total adipose tissue (r(2) = 0.941). The automated method required 6 min vs 2 h for the manual method.

CT has become the primary imaging modality for evaluation of possible appendicitis. About 20 % of patients taken to surgery for appendicitis without CT have had a normal appendix removed. CT has demonstrated overall accuracy of between 93 % and 98 %. Alternative diagnoses are seen in 34–80 % of patients without appendicitis but who were suspected of having appendicitis. For evaluation of appendicitis different techniques have been successful, including the use of no contrast, use of oral and intravenous contrast, and use of rectally administered contrast. Scanning of the entire abdomen and pelvis and scanning of an area limited to the right lower quadrant are also options. Ultrasonography has been shown to have a role in pediatric patients. If ultrasonography is positive, CT is not necessary. If ultrasonography is negative, CT should follow.

An extremely rare case of primary liposarcoma of the greater omentum is reported. A 51-year-old man was seen at the hospital because of abdominal distention. As a result of close examinations, the patient was diagnosed as having an intraabdominal tumor and was operated on. Upon laparotomy, a large volume of ascites was noted. The tumor was mainly present in the greater omentum, but a large number of small tumors with the diameters of 1 to 2cm were confirmed in the entire abdomen. The tumors were extirpated as possible as we could. The histopathological diagnosis was well differentiated liposarcoma partly with myxoid change. The prognosis was poor. The patient experienced recurrence four months after the operation and died after unsuccessful chemotherapy.

A case of giant (32 Kg) malignant fibrous histiocytoma (MFH) arising from the uterus and occupying the entire abdomen and the pelvis is reported. The patient had debulking surgery, followed by combination chemotherapy, but died 7 months after diagnosis.

Ziel der Arbeit: Es soll analysiert werden, inwieweit die Unterschiede zwischen den Organlagen des mathematischen Phantoms und den anatomischen Verhaltnissen des Menschen zu Fehlschatzungen der Organdosen und der effektiven Dosis fuhren konnen. Methodik: Fur die CT-Untersuchungen des Thorax, des Oberbauches, des Pankreas, des Beckens und des gesamten Abdomens wurden die Organdosen sowohl unter alleiniger Berucksichtigung der Organlagen des mathematischen Phantoms als auch unter genauerer Berucksichtigung der anatomischen Verhaltnisse des Menschen bestimmt. Ergebnisse: Beim Phantom liegen das Abdomen bei der CT-Untersuchung des Thorax und der gesamte Darm bei der CT-Untersuchung des Oberbauches sowie des Pankreas vollstandig auserhalb des Scanvolumens, wahrend der gesamte Darm bei der CT-Untersuchung des Beckens direkt exponiert wird. Bei Berucksichtigung der anatomischen Verhaltnisse des Menschen kann es zu Anderungen der berechneten Organdosen mit einem Faktor uber 15 und der effektiven Dosen mit einem Faktor unter 1,5 kommen. Schlusfolgerungen: Die Unterschiede zwischen den Organlagen des Phantoms und den anatomischen Verhaltnissen des Menschen konnen zu erheblicher Fehlschatzung der Dosen bestimmter Organe fuhren. Dagegen ist die effektive Dosis realistisch. Die Dosisabschatzung mittels mathematischer Phantome ist somit eine leistungsfahige Methode zur Abschatzung des radiogenen Gesamtrisikos. Purpose: To analyse how far dose calculations for the CT examination of the thorax and abdomen can lead to faulty estimations of organ doses and effective dose due to differences in the topographic anatomy between mathematical phantom and man. Methods: For the CT examination of the thorax, upper abdomen, pancreas, pelvis and the entire abdomen, organ doses were calculated with conversion factors, first with regard to the topographic relation within the phantom, then with additional regard to the real anatomy of the man. Results: In the phantom, the abdomen lies outside the scan volume in case of CT-examination of the thorax and the whole intestine outside the scan volume in case of CT-examination of the upper abdomen and the pancreas, whereas the entire intestine is directly exposed in case of CT-examination of the pelvis. Dependent on whether dose calculations take real anatomy into account, doses of special organs can differ by a factor greater than 15. The calculated effective doses differ by a factor less than 1.5. Conclusions: Calculations of organ doses for the CT examination of the thorax and abdomen can lead to considerable errors due to different topographic relations between phantom and man. In contrast, the calculated effective dose is realistic. Hence, dose calculations with the help of mathematical phantom is an efficient method to estimate the total radiogenic risk.

Immersive virtual environments use a stereoscopic head-mounted display and data glove to create high fidelity virtual experiences in which users can interact with three-dimensional models and perceive relationships at their true scale. This stands in stark contrast to traditional PACS-based infrastructure in which images are viewed as stacks of two-dimensional slices, or, at best, disembodied renderings. Although there has substantial innovation in immersive virtual environments for entertainment and consumer media, these technologies have not been widely applied in clinical applications. Here, we consider potential applications of immersive virtual environments for ventral hernia patients with abdominal computed tomography imaging data. Nearly a half million ventral hernias occur in the United States each year, and hernia repair is the most commonly performed general surgery operation worldwide. A significant problem in these conditions is communicating the urgency, degree of severity, and impact of a hernia (and potential repair) on patient quality of life. Hernias are defined by ruptures in the abdominal wall (i.e., the absence of healthy tissues) rather than a growth (e.g., cancer); therefore, understanding a hernia necessitates understanding the entire abdomen. Our environment allows surgeons and patients to view body scans at scale and interact with these virtual models using a data glove. This visualization and interaction allows users to perceive the relationship between physical structures and medical imaging data. The system provides close integration of PACS-based CT data with immersive virtual environments and creates opportunities to study and optimize interfaces for patient communication, operative planning, and medical education.

Computed Tomography (CT) examination of the entire abdomen and pelvis is more and more frequently performed in patients suspected of acute appendicitis but this examination can be obtained with various CT protocols. As there are still controversies regarding these protocols, this chapter will discuss their differences in terms of contrast material and anatomic coverage. This chapter will also review the CT features of acute appendicitis and the alternative diseases that can be detected at CT, including the impact of saving radiation dose on these features and alternative diagnoses.

The emergency laparotomy includes tasks and strategies that are drastically different than the elective laparotomy. The surgeon is constantly fighting an unforgiving foe: time. A moderately longer operation has little effect in outcome on a patient who is physiologically stable and not losing blood. On the other hand, every intraoperative minute counts on patients in metabolic disarray and hemodynamic collapse. Therefore, the entire philosophy of emergency abdominal access is dominated by the focus on minimizing time, while not compromising adequate exposure and technique. A standardization of tasks will prevent missed injuries, wrong procedures, or retained sponges, all of which are associated with emergency operations.

We present the case of an 8-year-old child with diffuse lipomatosis simultaneously involving the intra-peritoneum, retro-peritoneum and abdominal wall. To the best of our knowledge, this is the first case of diffuse lipomatosis with simultaneous multi-focal involvement of the entire abdomen.

This is the first clinical case report of a thoracic invasive thymoma metastatic to the ovary with disease noted in the entire abdomen including the pelvis 5 1/2 years after initial diagnosis. The involved areas of metastases include the distal ileum, peritoneal and serosal surfaces (including the surface of the distal colon, bladder, and pelvis), and the surface of the right ovary. The patient survived 13 years after her initial diagnosis and 7 1/2 years after discovery of her metastases. Thymomas are rare tumors but comprise the most common primary tumor of the anterior mediastinum. Extrathoracic metastases of malignant thymomas are also rare, and the literature reports that the most common sites for metastases are the liver, lung, lymph nodes, and bone. Extrathoracic disease is associated with a poor prognosis. The average time of survival after the diagnosis of metastases is 1.5 years.

Laparoscopy, and particularly robotically assisted laparoscopy, continues to advance rapidly, thus changing the practice of urology. The changes in the practice of pediatric urology, while slower, have also altered the surgical approach to various conditions of the genitourinary tract in children. While open procedure typically require a thorough working knowledge of smaller areas, the laparoscopic surgeon must have a thorough working knowledge of the entire abdomen and pelvis as they are in full view for all cases. In this chapter, we aim to provide the reader with the anatomic perspective associated with our new paradigm in surgical care.

The presence of a pelvic spleen is an exceedingly rare occurrence. Correct diagnosis, which is essential for appropriate management, can be suggested by sonographic evaluation and confirmed with the use of computed tomography. The case presented here demonstrates the necessity of examination of the entire abdomen by sonography when a pelvic mass of unknown etiology is encountered.

Giant hydronephrosis, NephrectomyGiant hydronephrosis, the collection of more than 1liter of fluid within the renal pelvi-calyceal system,is uncommon in adults. When it exists the kidneyand renal pelvis can extend across the midline andmay occupy the entire abdomen resulting in severalsymptoms or may still remain asymptomatic.

Although the majority of impalpable undescended testes lie in an intracanalicular location, a significant number are also found to be intraabdominal. The expected location of intraabdominal testes is a line joining the renal hilum and the internal inguinal ring. We describe a case of an adult patient in whom impalpable undescended testes were located in a retrovesical location. This case highlights the importance of performing a thorough inspection of the entire abdomen and pelvis if the impalpable testis is not found in an expected location.

The use of laparoscopy in general surgery has expanded to aid in the diagnosis of various intraabdominal conditions. A new application of the laparoscope is described to explore the abdominal cavity for potential gangrenous bowel after reduction of an incarcerated inguinal hernia. Hernioscopy allows for a good view of the entire abdomen including inspection of the colon for serosal changes of carcinoma. Exploration via this technique is accomplished without additional skin incisions or fascial disruptions and with no increased morbidity, when performed during the inguinal herniorrhaphy.

Both ‘perchers’ (Libellula saturata) and ‘fliers’ (Anax junius and Aeshna multicolor) remained active in the field in sunshine at air temperatures from at least 24 °C to 36 °C. The percher basked at low air temperatures and regulated exogenous heat input by postural adjustments. It markedly reduced flight activity at high air temperatures but flew nearly continuously at intermediate temperatures. In direct sunlight, the abdomen of L. saturata heated faster than the thorax, but this percher exhibited little or no capacity to transfer heat between abdomen and thorax. In contrast, the fliers gave no evidence of behavioural thermoregulation, but both showed impressive capacities for heat transfer from thorax to abdomen. When heated exogenously on the thorax the temperature of the entire abdomen of both fliers increased uniformly, but with endogenous heat production during pre-flight warm-up there was only a slight temperature increase near the anterior portion of the abdomen. Removal of abdominal air sacs or immobilizing the abdomen with wax to prevent all abdominal pumping did not significantly alter the capacity to transfer heat from thorax to abdomen. Ligation of the heart anywhere along the length of the abdomen abolished heat transfer. Given sufficient exogenous heat input, fliers that can regulate their thoracic temperature by transferring the excess heat to the abdomen died in about 2 min due to overheating when the heart was occluded. Under our experimental conditions the fliers appeared to thermoregulate exclusively via a control of blood circulation.

To identify patients at high risk for the development of enteric injury, an analysis was made of 212 women who received extensive pelvic and abdominal radiotherapy at the University of Minnesota from 1970 through 1981. One hundred one patients with cervical carcinomas received 8,000 to 8,500 rads to point A, 6,000 rads to point B, and 4,500 to 5,075 rads to the periaortic lymph nodes. One hundred eleven women with ovarian cancers received 2,000 rads to the entire abdomen, followed by an additional 2,975 to 3,000 rads to the pelvis. The overall complication rate was 6.6% (14/212). The only patients who sustained chronic radiation morbidity had thin physiques. The maximum likelihood multiple logistic model was utilized to predict the probability of enteric injury as a function of thin physique, previous operations, and hypertension for individual patients. The usefulness of predictive models is discussed, and possible reasons for the susceptibility of thin women to ionizing radiation are explored.

SARCOMA of the stomach is seldom encountered, if one may judge by the reports in the literature. Approximately 200 cases have been reported and they seem to be of more frequent occurrence than individual experience would lead one to infer. In the Berlin Pathological Institute, for instance, there is but one example of sarcoma of the stomach in the 840 specimens. In this discussion I have excluded lymphosarcoma, which is a fairly frequent finding. Frazier, in 1914, quotes Bruch as being the first to record a case of sarcoma of the stomach, in 1847. Virchow, in 1864, referred to three cases. Baldy, in 1893, reported the case of a patient who came to him complaining of a mass in the abdomen, which was accompanied by progressive weakness and loss of weight. Physical examination disclosed a large irregular mass filling the entire abdomen from the symphysis to the ensiform cartilage. A small hard mass, the size of a walnut, was found in the umbilicus. There had been no gastro-intestinal symptoms. Operation disc...

Unsuspected abnormalities are occasionally detected during real-time ultrasound examinations. To determine the frequency of these findings during standard, routine real-time abdominal survey, the records of 500 consecutive examinations were reviewed. We found that a significant number of important occult abnormalities were detected. The influence of the abdominal survey on clinical management and improved radiologic consultation is discussed.

A huge pancreatic pseudocyst which nearly filled the entire abdomen ruptured into the sigmoid colon, and caused perplexing clinical and radiographic findings. Because of the thickness of its wall, the pseudocyst did not collapse but became filled with intestinal gas. The more common features of pseudocysts that rupture are discussed.

The gastrointestinal radiologist no longer has to rely on indirect signs of extraluminal and solid organ pathology. With the use of the newer imaging modalities, including computed tomography, magnetic resonance imaging, and isotopic techniques, the entire abdomen and its contents can be directly visualized. Pathology, its extent and its effect on adjacent structures, can be readily appreciated.

Pneumoperitoneum cannot be diagnosticated from its physical signs, since any one of these may be present in tympanites. These signs, apparently first recognized by Barth and Roger, are: A high-pitched, tympanitic, often metallic, percussion note, uniform in quality over the entire abdomen. A diminished or absent area of liver flatness. A distended, tense abdominal wall. Embarrassment of the respiratory movements and the heart action. In clinical work the only sign much regarded is the obliteration of liver flatness, and against its reliability there is an increasing array of evidence. Osler 1 has spoken of the probability of its occurrence in tympanites; T. C. Janeway 2 of the proof of this at operation. Sprengel 3 considers it a sign of early spreading peritonitis. McCrae 4 says that if there is any degree of distention no dependence should be placed on it in the diagnosis

Irradiation of the entire abdomen is the logical therapy for ovarian carcinomas spread throughout the abdominal cavity, seminomas with massive periaortic lymph node involvement, and abdominal manifestations of the lymphomas. When irradiation is done either with kilovoltage or megavoltage, through large portals, marked systemic reactions can only be avoided by long protraction; it is likely that the dose administered will not be lethal to a high fraction of tumors.A moving strip technique using megavoltage is better tolerated. In this paper it is shown that a dose of 2,800 rads can be delivered to each segment of the abdomen in 12 days with local systemic reactions kept within safe limits during the treatment.A minimum period of 3 years has now[See table in the PDF file]elapsed in the study of the original patients, which makes an assessment of the late complications possible. No kidney or spinal cord sequelae have been observed.The original patients now have a minimum of 3 years follow-up, so that one can...

A case report in which a silver surgical clip was mistaken for the identifying metallic bar affixed to an Antigon intrauterine device (IUD) is presented. The tail of the device was found to be missing during a routine examination. Radiographic examination revealed a metallic clip outside the uterine cavity. Laparotomy however failed to locate the IUD outside of the uterine cavity. In patients wearing an IUD containing a bar metallic marker suspicion of uterine perforation must be carefully evaluated with regard to previous operations and X-rays of the entire abdomen are mandatory.

REPORT OF CASE H. P. S., aged 68, a laborer, was admitted to Rockford Hospital, Nov. 26, 1918, stating that about one hour previously he had fallen into a ditch about 7 feet deep, striking his chest on the rim of the ditch. At the time of his examination he complained of severe cramplike pain in the left upper quadrant of his abdomen. Slight contusions were found over the right upper thorax. The patient complained of severe tenderness on pressure over nearly the entire abdomen but more pronounced to the left of the umbilicus. There was a marked dulness extending into the flank and nearly to the midline. The pulse was 68; respiration, 20; temperature, 98.6; the urine was negative. Blood examination revealed: erythrocytes, 4,000,000; hemaglobin, 80 per cent.; leukocytes, 9,000. The patient's general condition seemed to be very good. Under local anesthesia a high left rectus incision was made

This case is reported as being of interest because of the extremely rapid genesis—six months—of a huge ovarian cyst. In the collapsed state it measured 15 by 15 by 6 cm., but it was so distended that it filled the entire abdomen and contained 15½ quarts (liters) of clear, straw-colored fluid. Six months before the operation, the patient underwent a normal delivery. Labor was of short duration and easy of accomplishment. Instruments were not used. During the course of her pregnancy she was well attended by a competent obstetrician and at no time were any complications or abnormalities noted. There is therefore every reason to believe that the patient did not have a large ovarian cyst during pregnancy and certainly not during labor. Moreover, the abdomen, post partum, returned to a normal size and was not noticeably distended until two weeks later. Consequently it is a most likely assumption that

A blacksmith, aged 48, entered the hospital, July 13, 1922, complaining of pain in the abdomen. Several days before admission, he developed a sharp pain, intermittent in character, over the entire abdomen at first, and later localizing in the right iliac region. There was no nausea or vomiting. The pain was not affected by, nor had it any relation to, the taking of food. Since the onset, the patient had had a gradual increase in frequency of urination, until, at the time of admission, he had a marked daily frequency and urinated five or six times at night. His temperature and pulse were normal on admission, and the leukocyte count was 6,300. The previous history was negative. The patient had not missed a day from his work on account of sickness in the past thirty years. The physical examination was negative except that there were many abscessed teeth and marked

On Dec. 5, 1906, we operated on Mrs. L. B., aged 43, for carcinoma of the right breast. The operation performed was a typical Halsted. The patient remained well until August, 1908, when she noticed a gradual enlarging of the abdomen accompanied by a feeling of weight and soreness, increasing difficulty with breathing, rapid heart action and occasional attacks of nausea and vomiting. In October, 1908, her abdomen had enlarged to such an extent that her physician, Dr. Lippincott, tapped her for the first time. Dr. Charles L. Ill saw her at this time and discovered a very much enlarged and nodular liver nearly filling the entire abdomen. It was his opinion that the woman could live but a short time. Five weeks after the October tapping, she was tapped a second time. The intervals of tapping were gradually decreased until she was tapped every six days. In January, 1910

The comparative rarity of lymphosarcoma of the intestine prompts me to report a case that came under my observation some months ago. REPORT OF CASE The patient, a woman, unmarried, aged 34, was admitted to the Illinois Central Hospital, Jan. 24, 1923, with a history of pain in the epigastrium and lower left quadrant. The onset occurred seven weeks previously with sudden, cramplike pain over the entire abdomen. A physician who was called prescribed a cathartic, which, however, gave no relief. The pain gradually decreased in severity and finally localized as a dull pain in the left lower quadrant. The patient was nauseated at the onset but did not vomit. Bowel movement had no influence on the pain. The history was otherwise unimportant. On examination a hard, irregular mass was palpable superficially at the level of the navel on the left side. The mass extended downward to the lower quadrant

History. —The patient, R. R. A., 0. S., was admitted to the hospital at 11 a. m., Dec. 10, 1909. Patient had reported at sickcall on morning of December 8, complaining of pain over entire abdomen, and diarrhea. On December 9, pain became localized in right iliac region. Temperature 99.5 F., pulse 82, respiration 18. On the evening of the 9th, temperature was 101 F., pulse 84, respiration 24; tenderness over right iliac region. Examination. —On admission to the hospital the temperature was 101 F., pulse 120 and respiration 22, with pain and tenderness over appendix and rigidity of right rectus muscle. The patient was prepared for operation, which was performed at 2 p. m. Just prior to the operation the temperature was 101.4 F., pulse 122, and respiration 22. Operation. —Under general anesthesia (ether) and with the usual aseptic and antiseptic precautions, an incision was made over McBurney's point

Every case of appendicitis is of some clinical interest to surgeon and physician alike; but some cases stand out on account either of the operative findings or of the complications which follow. It is to the latter class that the following case belongs; and I believe its report will be read with some interest, particularly since it terminated in a complete recovery. History. —W. M., man, aged 21, walked into my office, March 15, 1915, leaning forward and very lame apparently in the right hip, saying he had appendicitis. He had been taken sick, March 10, with indigestion, pain in the stomach and vomiting; March 14, there had been severe pain in the lower right flank, but at present the pain was felt over the entire abdomen. The temperature was 99, pulse 140, abdomen rigid. Vomiting had ceased the day before. The bowels had acted in the morning from a

M. S., a white girl, aged 14, was brought by ambulance to Beth Moses Hospital, Sept. 21, 1927, to be immediately operated on for general peritonitis following acute appendicitis. An emergency operation was performed a few hours later. The patient was very ill, and so the history, of necessity, had to be curtailed to only the pertinent facts. Two days prior to the date of admission, the patient was seized with severe generalized abdominal pains, more so in the uppermost portions of the abdomen. She vomited several times ou the day of onset, and the following day. She felt feverish. The pains subsided for a time but then recurred, on the second day with increased severity, localizing themselves to the right lower quadrant. No urinary symptoms were complained of. She had never menstruated. Physical examination revealed tenderness throughout the entire abdomen, especially in the lower abdomen. There was definite rigidity

The "football" or "air dome" sign was described as a "New Roentgen Sign" in 1960 by Miller.1Prior to this the usual supine film for free air in the peritoneal cavity was considered nondiagnostic. In the newborn the "football" sign is pathognomonic of free air in the abdomen. The oval shadow of the entire abdomen is the "football," and the falciform ligament of the liver is seen as the "seam of the ball." The "seam" is located in the cephalad half of the film, but may be continued caudally by the shadow of the urachus (Fig. 1). The purpose of this paper is to relate our experiences in 3 cases and to emphasize the value of this diagnostic sign. Report of Cases Case1.—Figure 1 illustrates this roentgen finding in a 2-day-old, 4 lb. (about 1,814 gm.), premature infant who died at 2 days of age. The diagnosis of