248 ABSTRACTS CLINICAL IMAGING VOL. 13, NO. 3

tients required surgical intervention for drainage of retroperitoneal abscess (3) or a pseudocyst (1). A fifth patient required intensive care resuscitation for sep- tic shock. We conclude CT is the study of choice for evaluating the patient with suspected complication following ERCP and sphincterotomy.

Author’s summary

patients, including two patients in whom erroneous diagnoses of pancreatic pseudocyst and pancreatic abscess were suggested based on CT findings. The duodenal diverticulum was visualized on CT in 10 of 14 patients (71%). The CT appearance was vari- able, with some diverticula containing air, fluid, contrast medium, or a mixture of the three.

Author’s summary

SONOGRAPHIC DIAGNOSIS OF CHOLANGITIS IN AIDS PATIENTS Defalque D, Menu Y, Girard P-M, Coulaud J-P (M.Y.: Hopital Beaujon, Service de Radiologie, 100 bvd du General Leclerc, F-92118 Clichy Cedex, France) Gastrointest Radio1 1989;14:143-147.

Eleven acquired immunodeficiency syndrome (AIDS) patients were initially evaluated by ultra- sound of the liver because of biochemical evidence of cholestasis. Sonography was very useful for demonstrating dilation and/or wall thickening of the common bile duct associated with dilated intrahe- patic bile ducts. Periportal hypoechoic or hypere- choic areas were also visualized. In seven patients, gallbladder walls were thickened. In six patients, the diagnosis of cholangitis was confirmed by endo- scopic retrograde cholangiography and/or histology. Cytomegalovirus infection or digestive tract crypto- sporidiosis were often present and accounted for diarrhea in most patients.

We believe the association of upper right quadrant pain and anicteric cholestasis in the course of AIDS is suggestive of cholangitis, but a disparity may exist between mild symptoms and sonographically dem- onstrated extensive biliary involvement.

Author’s summary

COMPUTED TOMOGRAPHY OF DUODENAL DIVERTICULA Stone EE, Brant WE, Smith GB (DGMCSGHR Travis Air Force Base, CA 94535, U.S.A.) J Comput Assist Tomogr 1989;13:61-63.

Duodenal diverticula are common and usually con- sidered to be incidental findings. However, they may cause significant patient morbidity due to inflam- matory or pressure effects and may be mistaken for pancreatic pathology on computed tomography (CT). We correlated the CT and upper gastrointestinal series appearance of duodenal diverticula in 14

THE USE OF PREOPERATIVE LOCALIZATION OF ADENOMAS OF THE PARATHYROID GLANDS BY THALLIUM TECHNETIUM SUBTRACTION SCINTIGRAPHY, HIGH- RESOLUTION ULTRASONOGRAPHY, AND COMPUTED TOMOGRAPHY Roses DF, Sudarsky LA, Sanger J, et al. (New York University Medical Center, 530 First Avenue, New York, NY 10016, U.S.A.) Surg Gynecol Obstet 1989:168:99-106.

Thirty-six patients with primary hyperparathyroid- ism were studied preoperatively by thallium-261 and technetium-99m pertechnetate subtraction (Tl- ZOl/Tc-99m) scintigraphy, high-resolutional real time ultrasonography, and computed tomography (CT) scanning. None of the patients had had previ- ous surgical treatment of the parathyroid or thyroid glands. All of the patients underwent systematic bilateral exploration of the neck. All of the patients were successfully explored and 41 abnormal para- thyroid glands were identified. Five patients had two adenomas. In six instances, adenomas were iden- tified in ectopic anatomic sites. The sensitivity of correctly localizing the abnormal glands with these techniques was 49% for the Tl-201/Tc-99m scintig- raphy, 34% for ultrasonography, and 41% for CT scanning. The Tl-201/Tc-99m scintigrams de- tected two of the six ectopically located adenomas, CT detected one, while ultrasound detected none. The five patients with multiple adenomas were not accurately identified as having multiple gland en- largement by any of these studies.

Author’s summary

CLONORCHIASIS: SONOGRAPHIC FINDINGS IN 59 PROVED CASES Lim JH, Ko YT, Lee DH, Kim SY (Department of Diagnostic Radiology, Kyung Hee University Hospital, 1, Hoeki-dong, Dongdaekun-ku, Seoul 130-702, Korea) AJR 1989;152:761-764.

SEPTEMBER 1989 ABSTRACTS 249

Clonorchiasis is a parasitic disease of the bile ducts that occurs in endemic areas after ingestion of raw flesh of freshwater fish. We analyzed the sono- graphic findings in 59 patients with clonorchiasis, suspected prospectively from sonographic findings and proved subsequently by demonstration of eggs in their stools. Diffuse dilatation of the small intra- hepatic bile ducts with no or minimal dilatation of the large intrahepatic and extrahepatic ducts was observed in all cases. The extrahepatic ducts were patent throughout in all except one case. This char- acteristic finding reflects diffuse intrahepatic bile duct obstruction and resultant proximal dilatation caused by an adult worm or aggregates of worms, as worms reside diffusely in the medium and small intrahepatic bile ducts. Cholangitis and multifocal periductal fibrosis with proximal dilatation may play an additional role. Increased echogenicity of the intrahepatic bile duct wall was present in 39 cases (66%), reflecting cholangitis and periductal fibrosis. In 17 cases (29%), floating or dependent, discrete, nonshadowing, intraluminal, echogenic foci caused by adult worms in the bile were demonstrated in the gallbladder. These echogenic foci were distin- guished from stones because they were fusiform, weak in echogenicity, and floated with a change in position.

Clonorchiasis should be considered when so- nography discloses the characteristic pattern of bile duct dilatation with increased wall echogenicity and nonshadowing, discrete, echogenic foci in gallblad- der lumen.

Author’s Summary

cases the glutei, and in one case each the lateral abdominal wall, the pelvis, the inguino-scrotal area, and the calf of the leg. Eight cases have already shown a recurrence after the initial treatment. MRI performed in these eight cases showed a close rela- tionship between an intense signal on T2-weighted images and presence of a recurrent tumor. The demonstration of a low-intensity signal on the T2- weighted images was instead evidence of a process of repair with fibrotic tissue. It has been shown (Hamlin DJ, et al., 1986; and Petterson H, et al., 1987) that MRI of fibromatosis before treatment shows a low signal in the Tl and T2 sequences.

Antonio F. Govoni, MD

[Although Clonorchis sinensis is prevalent in the Far East, infected persons immigrating to nonen- demic areas, and persons traveling to endemic areas could become infected. The importance of the sono- graphic findings of this disease is stressed. A.F.G.)

VALUE OF MAGNETIC RESONANCE IMAGING IN THE FOLLOW-UP OF FIBROMATOSIS (IN FRENCH) Vane1 D, Ubaldino V, Coffre C, et al. (Service de Radiologie, Institut Gustave-Roussy, Rue Camille- Desmouiins, F-94805 Villejuif Cedex, France) J Radio1 1989;70:33-36.

CONTRIBUTION OF COMPUTED TOMOGRAPHY IN THE AETIOLOGY AND PROGNOSIS OF CEREBRAL PALSY IN CHILDREN Schouman-Claeys E, Picard A, Lalande G, et al. (Hopital Raymond Poincare, F-92380 Garches, France) Br J Radio1 1989;62:248-252.

Retrospective analysis of computed tomography (CT) examinations in 76 children with cerebral palsy without any severe intellectual handicap has re- vealed abnormalities in 63% of these children; ab- normalities were present in 88% of former preterm infants. This study highlights the significant path- ogenic role of periventricular leucomalacia in cere- bra1 palsy, since in 45% of the cases of this series this diagnosis had been reached as a result of a character- istic CT appearance associated with a history of premature birth and very specific clinical deficits. The CT abnormalities, mostly posterior and gener- ally bilateral and symmetrical, affect the contours of the lateral ventricles, which become straight and angular, and often involve ventriculomegaly (85%). Localized juxtaventricular hypodensities were only found in a few cases (6%). The cognitive and intel- lectual sequelae in these children were more severe than in those children whose CT examination was normal, and were also more pronounced when the longitudinal fissure of the cerebrum was enlarged.

Author’s summary

MR AND CT OF MASSES OF THE ANTEROSUPERIOR THIRD VENTRICLE

This is a retrospective study of 10 patients with Waggenspack GA, Guinto FC Jr (Department of fibromatosis studied by magnetic resonance imaging Radiology, Division of Neurology, University of (MRl) between April 1985 and June 1987. In four Texas Medical Branch, Galveston, TX 77550-G09, cases, the lesion involved the popliteal fossa, in two U.S.A.) AJR 1989;152:609-614.