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T he purpose of this article is to define the anatomic relationships of the continuum of the intraperitoneal and extraperitoneal tissues of the abdomen and pelvis called the subperitoneal space and to establish the clinical usefulness in identifying the direct spread of disease by modem imaging techniques. In clinical practice and in diagnostic imaging of the abdomen and pelvis, it has been useful to distinguish between intraperitoneal and extraperitoneal organs, structures. and compartments. Concepts introduced and established over the past two decades regarding the spread and localization of the full range of disease processes in the abdomen and pelvis have been universally adopted [1-5]. Whether of inflammatory, malignant, or traumatic origin, spread and localization are determined by dynamic and anatomic features related to the peritoneal mesenteries and ligaments. the peritoneal recesses. and the three extraperitoneal spaces and their continuity with pelvic compartments. On the basis of pathogenesis and recognized anatomic avenues of dissemination, characteristic imaging features often lead to uncovering an occult primary site and to anticipating sites of extension, thereby permitting accurate prognosis and appropriate management. Nonetheless, instances are encountered in which the sites of the presence or extension of disease states in the abdomen and pelvis appear paradoxical. Our recent experience leads to the unifying conclusion that, indeed, intraperitoneal and extraperitoneal structures constitute an anatomic continuum (the embryologic development ordains that the mesenchyme beneath the peritoneum is a substrate in continuity throughout the body) and that these anatomic planes of continuity serve as pathways for the spread of disease. The holistic paradigm conceptualizes the abdomen and pelvis as a single space interconnected by planes. In acknowledging this continuum deep in relation to the peritoneum with its subserous connective tissue, we have designated this the subperitoneal space (Fig. I ). Thus, it is essential to recognize that this space and its discrete planes of continuity provide the avenues for bidirectional spread of disease between intraperitoneal and extraperitoneal sites and structures [6-14].

The subperitoneal space is the continuous space interconnecting the peritoneum and retroperitoneum and the abdominal organs. This report expands the concept of direct spread of disease via the subperitoneal space to include direct extension into the solid abdominal viscera (i.e., liver, kidneys, and spleen). Discussion of the anatomy, case presentations, and imaging with computed tomography, ultrasound, and magnetic resonance are presented. This unifying concept provides an understanding for direct spread of disease presenting clinically or being imaged within a solid abdominal organ.

The direct spread of intraabdominal disease via peritoneal folds is clearly demonstrated with computed tomography (CT). This extensive network of peritoneal folds can be conceptualized as the subperitoneal space. These subperitoneal communications within the abdomen are described and demonstrated by CT scans and a schematic drawing. Direct spread of disease within and between abdominal compartments is illustrated with selected clinical cases stressing the CT imaging method.

Computed tomography (CT) was used in the management of four patients with periorbital inflammation. These patients were selected for CT scanning because of the difficulty, on clinical examination alone, in determining the degree of orbital disease. The CT scans confirmed the presence and defined the location of an orbital abscess in three patients and eliminated the presence of an abscess in the fourth. On the basis of this experience, CT scanning is recommended in the evaluation of children with periorbital inflammation in whom proptosis, ophthalmoplegia, or loss of visual acuity develops, or in whom severe eyelid edema prevents adequate eye examination.

ALTHOUGH idiopathic dilatation of the main pulmonary artery had been described in several previous reports1 2 3 4 5 6 7 8 9 10 11 12 it was not until 1949 that Greene et al.13 laid down criteria fo...

Pneumomediastinography has proved to be an excellent radiological method for studying the size, extent, and gross anatomical characteristics of mediastinal masses (1, 2, 5, 10, 11). It has also been employed successfully in estimating thymic size in autoimmune diseases and in studying the response of the thymus gland after steroid therapy (9, 11). To our knowledge there have been two European papers and a single American paper which discuss the results of pneumomediastinography in evaluating bronchogenic carcinoma (1, 6, 10). The purposes of this report are to describe the recent modifications of our original method of pneumomediastinography (2) and to relate our experience with this procedure in evaluating 64 instances of suspected bronchogenic carcinoma. We shall emphasize the rationale for and the technical details of successful pneumomediastinography and also describe radiological principles and criteria for the interpretation of pneumomediastinograms. Rationale Using injection technics, Marchand exam...

A radiolucent linear shadow can be seen on plain radiographs in the right upper quadrant of 30% of patients. The surface anatomy of the liver and its associated ligaments were studied in the cadaver, clinically, and in surgical patients to determine the cause of this shadow. From these studies it is concluded that the shadow is cast by the fat that normally surrounds the ligamentum teres hepatis. The soft-tissue “mass” that the fat shadow demarcates should not be interpreted as a pathological process.

THE delineation of the normal structures and pathologic processes within the mediastinum is one of the most difficult aspects of chest roentgenology. The anatomic complexity of the mediastinal contents and their similar radiologic densities preclude precise x-ray visualization. Barium esophagography,1 , 2 overpenetrated films3 , 4 and vertical and horizontal laminagraphy,5 as well as the complicated contrast technics of angiocardiography and opacification of the azygos vein and superior vena cava,6 , 7 are widely employed to improve the radiologic study of the mediastinal structures. Theoretically, the introduction of gas as a contrast material into the various soft-tissue planes of the mediastinum, pneumomediastinography, should be the ideal . . .

Reports of isolated congenital mitral insufficiency have been sparse. We have had theunusual opportunity of studying 16 cases. This congenital lesion as noted in these sixteen patients has presented with a clinical finding hitherto unreported which we think is presumptively diagnostic. The murmurs noted in these patients differ from those of mitral insufficiency of other etiologies. The regurgitant murmur has a marked distribution and intensity over the left posterior thorax which is most likely due to a congenitally widely dilated mitral valve ring. The pulmonary artery wedge pressure or left atrial pulse contours have been found to be of value in the diagnosis. The single most important diagnostic test has been selective left ventricular angiography.

IN 1812 Meckel described the congenital diverticulum of the small intestine that now bears his name. Although this lesion has been discovered in 1 or 2 per cent of various autopsy series, notoriously the roentgenographic demonstration of Meckel's diverticulum is not frequently accomplished.1 2 3 4 Up to 1958 no more than 30 or 40 cases so diagnosed had been reported.5 6 7 8 9 10 11 12 13 14 Many physicians, including radiologists, have commented upon the infrequency of the roentgenologic diagnosis and have made statements such as the following: "Roentgenologic examinations have been demonstrated as practically useless in attempts to visualize the lesion [Meckel's diverticulum]...."15 16 17 18 19 20 This report will serve to . . .