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The CT appearance of hemiazygos continuation of a left-sided inferior vena cava is presented along with discussion of associated anomalies.

Seventeen renal transplant patients with pelvic lymphatic fluid collections were treated with percutaneous drainage. Eleven of 16 patients with lymphoceles (69%) were successfully managed without surgery, although seven of these patients required repeat catheter insertions, and three patients developed local infections. The patient with an ovarian cystadenoma was treated with surgery. The mean duration of catheter insertion was ten days for initial drainage and 16 days for repeat drainage. Elevated serum creatinines decreased in 14 of the patients with lymphoceles (88%), including all five patients without pelvocaliectasis, but never returned to baseline in six instances. This observation may reflect the inadequate therapy of frequently encountered concurrent renal parenchymal abnormalities (rejection, cyclosporine toxicity, acute tubular necrosis). While percutaneous management of lymphoceles is technically easy and usually ultimately effective, the interventional radiologist should be prepared for long duration of catheter insertions, repeat interventions, and variable clinical courses. Differentiation of lymphoceles from other fluid collections, such as cystic ovarian neoplasms, may be difficult.

Six patients with small solid renal tumors were evaluated by computed tomography (CT). Two patients had renal oncocytomas, three had small renal cell adenocarcinomas, and one had separate foci of each of these tumors in the same kidney. We describe several features that may alert the clinician to the possible presence of oncocytoma. We found, however, that unless the dense central scar that can be seen in larger oncocytomas is visualized on CT (as was the case in one of our patients), differentiation between oncocytomas and renal cell carcinomas by CT is not possible.

The CT examinations and medical records of 33 patients with primary retroperitoneal malignancies were reviewed. Computed tomography findings were then compared with those from scans performed on 122 patients with non-Hodgkin lymphoma who presented during the same time interval. Primary retroperitoneal neoplasms had three distinct CT appearances. Twenty-one patients (64%) had large soft tissue masses. Seven patients (21%) had masses with fatty density components, and five patients (15%) had tumors that were primarily of water attenuation. With the exception of those liposarcomas that contained recognizable fat, CT could not distinguish among the different cell types. Seventeen patients with non-Hodgkin lymphoma had large dominant retroperitoneal soft tissue masses that resembled primary retroperitoneal malignancies. In most cases, however, CT was able to differentiate these tumor masses from primary retroperitoneal tumors. Although 19 of 20 sarcomas of soft tissue attenuation were heterogeneous, only six of the 17 lymphomas presenting as dominant masses had such an appearance. Computed tomography is extremely helpful in initially evaluating patients with primary retroperitoneal tumors and in assisting the surgeon in planning his or her approach by accurately defining tumor extent.

A double-blind, random distribution study showed that a lower than recommended dose of minocycline--50 mg twice daily--was as effective as a dose of 250 mg twice daily of tetracycline for treatment of acne vulgaris in comparable patient groups, and that minocycline produced no vestibular side effects at the lower dosage. Like tetracycline, minocycline did not produce the phototoxicity associated with demeclocycline or the life-threatening colitis associated with clindamycin. Patients in this study did not develop a resistance either to minocycline or to tetracycline. Studies of the use of minocycline in patients who have developed tetracycline resistance and long-range studies of patients on the new lower dose of minocycline are now underway.

We report the CT findings in a case of primary seminal vesicle carcinoma. These consisted of unilateral enlargement of a seminal vesicle with associated stranding extending into the surrounding fat. This soft tissue stranding corresponded pathologically to direct tumor invasion.

Lumbar hernias occur in the region of the flank bounded by the 12th rib, the iliac crest, and the erector spinae and external oblique muscles. We present the CT findings of seven lumbar hernias: six traumatic (four secondary to postoperative flank incisions, one secondary to an iliac bone-graft donor site, one secondary to nonunion of an iliac fracture) and one spontaneous. Because CT portrays the anatomic relationships in this region so well, it may be the only radiographic procedure necessary to make the diagnosis of a lumbar hernia. Furthermore, it can be helpful in the assessment of symptomatic patients after flank incision, to differentiate postincisional muscular weakness and intercostal neuralgia from a lumbar hernia.

This study was undertaken to evaluate hemodialysis-associated subclavian vein stenosis (SVS) and to clarify treatment of this condition. Forty-seven patients underwent upper arm venography to evaluate fistula dysfunction. Subclavian vein stenosis was documented in 12. Eleven of 12 had elevated venous dialysis pressure (196 +/- 8.9 mm Hg), and six had arm edema. All 12 had previously undergone subclavian cannulation on the side of the fistula. Thirty-five patients showed no evidence of subclavian vein stenosis. Twelve of these 35 patients (mean venous dialysis pressure 113 +/- 2.3 mm Hg) had undergone previous subclavian cannulation on the side of the fistula. The mean age of the fistula at the time of venogram in patients with subclavian vein stenosis was 17.0 months versus 5.8 months in patients with ipsilateral subclavian cannulation without subclavian vein stenosis. Percutaneous transluminal angioplasty (PTA) was performed on 11 of 12 patients with SVS lowering venous dialysis pressure and restoring patency to the fistula in 100%. Lesions recurred in two of 11 patients and were successfully retreated with PTA. We conclude that SVS is a common dialysis problem that is amenable to treatment with PTA. Elevated venous dialysis pressures are a sensitive indicator of this condition.

A case of diffuse xanthogranulomatous pyelonephritis of the kidney with an associated renocolic fistula is reported. Computed tomography demonstrated typical findings with an enlarged poorly functioning kidney with multiple near-water-density masses replacing the renal parenchyma surrounding a central staghorn calculus. A mottled gas collection within the renal parenchyma was secondary to a renocolic fistula rather than a pyogenic abscess.

Ultrasound scans of 51 consecutive patients with gallbladder wall thickening were reviewed, and specific sonographic features were correlated with surgical and clinical follow-up. Two patterns of thickening were identified as specific indicators of the presence or absence of acute cholecystitis. "Striated" wall thickening, consisting of several alternating, irregular, discontinuous, lucent and echogenic bands, was seen in eight of 13 patients (62%) with acute cholecystitis. This pattern was not encountered in any of the patients who did not have acute cholecystitis. Conversely, "three-layer" thickening, consisting of a single circumferential lucent zone between two relatively uniform echogenic layers, was seen in only one of 13 patients (8%) with acute cholecystitis but in 11 of 38 patients (29%) with other diagnoses. Other abnormalities, including the presence of intramural echogenic foci and wall irregularities, were more frequently seen in patients with acute cholecystitis but were not as helpful. Use of these features may suggest or help exclude a diagnosis of acute cholecystitis in those patients in whom the cause of gallbladder wall thickening is otherwise not apparent.

Of 65 surgically removed donor kidneys intravenous digital subtraction angiography demonstrated accurately the number of renal arteries in 58 (89 per cent). All accessory vessels missed at digital subtraction angiography were small and their presence did not interfere with successful transplantation in those donated. Of 50 surgically removed donor kidneys examined with conventional aortography only before the routine use of intravenous digital subtraction angiography the number of renal arteries was demonstrated accurately in 46 (92 per cent). Intravenous digital subtraction angiography offers advantages over conventional aortography, including most importantly the routine performance on an outpatient basis, and decreased film cost and examination time. Although the accuracy of conventional aortography (92 per cent) in detecting the number of renal arteries is slightly greater than that for intravenous digital subtraction angiography (89 per cent), the advantages of the digital examination justify its use as the initial examination for the potential renal donor. Conventional aortography can be reserved for use in patients with equivocal or technically inadequate digital examinations.