Emil Balthazar, M.D.

Comparison of diagnostic accuracy of upright Vs. recumbent esophagram in predicting hiatal hernia
Parikh M.; Heacock L.; Hindman N.; Jain R.; Balthazar E.
2011 ;21(8):1070-1070, Obesity surgery
Background: Hiatal hernia repair at the time of bariatric surgery improves patient outcome, decreases GERD symptoms and reduces the need for reoperation. The aim of this report is twofold: first, to compare the sensitivity of esophagram with surgical findings at the time of bariatric surgery, and second, to compare the sensitivities of upright versus right anterior oblique (RAO) recumbent esophagram in predicting the presence of hiatal hernia intraoperatively. Methods: Between 2008 and 2010, 389 patients undergoing bariatric surgery were prospectively evaluated for hiatal hernia by barium esophagram. 70 (18%) were performed only in the upright position and 319 (82%) only in the RAO recumbent position. Esophagram technique was changed from upright to recumbent because we hypothesized that we would be able to better detect hiatal hernia utilizing RAO recumbent technique. Hiatal hernia was assessed intraoperatively by laxity/dimpling of the phrenoesophageal ligament and, when present, was repaired posteriorly with permanent sutures. Results: Compared with the surgical findings, the sensitivity and specificity for upright esophagram was 50% and 97%, respectively. For recumbent esophagram, sensitivity was 70% and specificity was 77%. Recumbent esophagram had a lower percentage of false negatives than upright esophagram (11% vs. 21%). Conclusions: Use of a recumbent technique for preoperative esophagram has a higher sensitivity for diagnosis of hiatal hernia than upright esophagram. Routine use of recumbent esophagram results in increased preoperative detection of hiatal hernia and facilitates planning of crural closure
— id: 137856, year: 2011, vol: 21, page: 1070, stat: Journal Article,

Imaging of the pancreas : acute and chronic pancreatitis
Balthazar, Emil J; Megibow, Alec J; Mucelli, Roberto Pozzi
Berlin : Springer, 2009,
— id: 2080, year: 2009, vol: , page: , stat: ,

MDCT of acute mild (nonnecrotizing) pancreatitis: abdominal complications and fate of fluid collections
Lenhart, Dipti K; Balthazar, Emil J
2008 Mar;190(3):643-649, American journal of roentgenology
OBJECTIVE: The objective of our study was to describe the occurrence of local complications and the fate of fluid collections in milder forms of acute nonnecrotizing pancreatitis. MATERIALS AND METHODS: Initial MDCT studies of 169 consecutive patients with mild acute pancreatitis and 203 follow-up CT examinations were reviewed. The fate of peripancreatic fluid collections was investigated, and the incidence and type of local complications were recorded and correlated to the CT grading system (A-E). RESULTS: Complications developed in nine of 169 patients, for an incidence of 5.3%. All morbidity occurred in the subgroup of 73 patients with initial fluid collections, for an incidence of 12.3%. Follow-up CT examinations available in 51 of these 73 patients documented rapid fluid resolution in 35 cases (68.6%) and persistence of fluid more than 2 weeks from onset in seven asymptomatic patients (13.7%). Acute, life-threatening complications (hemorrhage, infection, perforation) occurred in five patients, for an incidence of 6.8% among the 73 patients with initial fluid collections, or 3.0% in the entire group of 169 patients. Five patients developed acute pseudocysts. Long-term follow-up studies discovered two patients with chronic pancreatitis and one with groove pancreatitis. CONCLUSION: A small number of acute, life-threatening abdominal complications and chronic complications are expected to occur in patients with milder forms of acute nonnecrotizing pancreatitis presenting with fluid collections. In these patients, clinical monitoring and repeated imaging studies are recommended to document the resolution of fluid or the development of complications
— id: 76864, year: 2008, vol: 190, page: 643, stat: Journal Article,

A pattern approach to the abnormal small bowel: observations at MDCT and CT enterography
Macari, Michael; Megibow, Alec J; Balthazar, Emil J
2007 May;188(5):1344-1355, American journal of roentgenology
OBJECTIVE: Imaging of the vast array of pathologic processes occurring in the small bowel has been facilitated by recent advances, including the use of MDCT scanners that acquire isotropic data and neutral oral contrast agents that improve small-bowel distention. CONCLUSION: This review shows how a systematic pattern approach can be used to narrow the differential diagnosis when an abnormal small-bowel loop is detected on MDCT
— id: 71932, year: 2007, vol: 188, page: 1344, stat: Journal Article,

Pancreatitis associated with pancreatic carcinoma. Preoperative diagnosis: role of CT imaging in detection and evaluation
Balthazar, E J
2005 ;5(4-5):330-344, Pancreatology
The combined occurrence of pancreatic carcinoma with acute or chronic pancreatitis is seldom seen in medical practice, but when present it is a challenging dilemma, plagued by confusing overlapping clinical findings and pitfalls in diagnostic imaging tests. This article reviews the presumptive pathophysiological aspects of this relationship, the perplexing clinical presentations and the advantages and limitations of the noninvasive imaging examinations. The role of state-of-the-art CT imaging in screening patients with acute and chronic pancreatitis is emphasized and the impute of additional more invasive tests in detecting pancreatic tumors in this cohort of patients is reviewed. The habitual use of CT imaging, followed when needed by complementary examinations, can improve on previously reported low detection rates and hopefully decrease the number of exploratory laparatomies and unnecessary major pancreatic surgical resections
— id: 106954, year: 2005, vol: 5, page: 330, stat: Journal Article,

CT of Meckel's diverticulitis in 11 patients
Bennett, Genevieve L; Birnbaum, Bernard A; Balthazar, Emil J
2004 Mar;182(3):625-629, American journal of roentgenology
OBJECTIVE: This study reviews the CT findings of Meckel's diverticulitis in 11 patients and, to our knowledge, represents the largest series of such cases reported to date. CONCLUSION: The inflamed Meckel's diverticulum may be visualized on CT in most patients, appearing as a blind-ending pouch of variable size and mural thickness and containing fluid, air, or particulate material with surrounding mesenteric inflammation. The location of the diverticulum may vary from the right lower quadrant to the mid abdomen, with most cases in this series located near midline. Optimal luminal opacification of the ileocecal bowel with oral contrast material facilitated detection of the diverticulum and also proved invaluable in enabling identification of the normal appendix. The diagnosis is most difficult in the setting of secondary intestinal obstruction
— id: 42587, year: 2004, vol: 182, page: 625, stat: Journal Article,

Imaging of the acute abdomen
Balthazar EJ
Philadelphia : Saunders, 2003,
— id: 779, year: 2003, vol: , page: , stat: ,

Imaging of the acute abdomen - Preface
Balthazar, EJ
2003 NOV ;41(6):XI-XII, Radiologic clinics of North America
— id: 55408, year: 2003, vol: 41, page: XI, stat: Journal Article,

Ultrasound and CT evaluation of emergent gallbladder pathology
Bennett, Genevieve L; Balthazar, Emil J
2003 Nov;41(6):1203-1216, Radiologic clinics of North America
Ultrasound is the initial imaging modality of choice for the evaluation of suspected acute gallbladder disorders, and is often sufficient for correct diagnosis. CT also plays a vital role, however, in the evaluation of acute gallbladder pathology. CT is particularly useful in situations where ultrasound findings are equivocal. CT is also extremely valuable in the assessment of suspected complications of acute cholecystitis, particularly emphysematous cholecystitis, hemorrhagic cholecystitis, and gallbladder perforation, which are often very difficult diagnoses to establish at sonography. If CT is the initial imaging test performed in a patient with abdominal pain of uncertain etiology, recognition of the various disorders described in this article may eliminate the need for further imaging and facilitate appropriate management
— id: 43877, year: 2003, vol: 41, page: 1203, stat: Journal Article,

The acute right lower quadrant: CT evaluation
Macari, Michael; Balthazar, Emil J
2003 Nov;41(6):1117-1136, Radiologic clinics of North America
Acute right lower quadrant pain is a nonspecific but common clinical complaint. Appendicitis is the most common cause of acute right lower quadrant pain and CT has become the most reliable imaging method in the evaluation of these patients. Although there is controversy regarding the best way to perform CT in this setting, oral and i.v. contrast-enhanced CT remains the most commonly used technique. CT with oral and i.v. contrast material facilitates diagnosis of appendicitis and the numerous other entities that may cause right lower quadrant pain
— id: 43878, year: 2003, vol: 41, page: 1117, stat: Journal Article,

Intestinal ischemia versus intramural hemorrhage: CT evaluation
Macari, Michael; Chandarana, Hersch; Balthazar, Emil; Babb, James
2003 Jan;180(1):177-184, American journal of roentgenology
OBJECTIVE: We evaluated the capability of CT to depict findings that allowed differentiation of small-bowel ischemia from intramural hemorrhage. MATERIALS AND METHODS: Findings of 35 CT examinations (19 patients with small-bowel ischemia and 16 patients with intramural hemorrhage) were analyzed by two abdominal radiologists for the degree of wall thickening, location and length of involvement (short, <or = 15 cm; medium, 16-30 cm; or long, >30 cm), presence of hemoperitoneum, and pattern of attenuation. Patency and caliber of the superior mesenteric artery and vein were noted. Diagnosis was confirmed by laboratory findings, clinical parameters, and follow-up examinations, or at surgery. A Mann-Whitney U or Fisher's exact test was used to compare the two conditions for the following features: wall thickening, location and length of involvement, presence of hemoperitoneum, and appearance of the target sign. RESULTS: Among the 35 examinations, 18 abnormal segments with intramural hemorrhage and 19 abnormal segments with ischemia were identified. (Two patients with intramural hemorrhage each had two segments involved.) Mean bowel wall thickness was 11.7 mm (range, 4-25 mm) in patients with intramural hemorrhage and 4.0 mm (range, 1-9 mm) in patients with ischemia. Length of involvement was short in 14 segments with intramural hemorrhage and medium in four segments with intramural hemorrhage; none of the segments with intramural hemorrhage had long involvement. Among the segments with ischemia, length of involvement was medium in three and long in 16; none of the ischemic segments had short involvement. Fifteen (94%) of 16 segments with intramural hemorrhage and six (32%) of 19 segments with ischemia had hemoperitoneum. Seven of the 18 segments with intramural hemorrhage and nine of the 19 with ischemia had a target sign. Segments with intramural hemorrhage exhibited a higher statistically significant degree of wall thickening (p < 0.001), a shorter length of involvement (p < 0.0001), and a higher incidence of hemoperitoneum (p < 0.001) than did segments with ischemia. The two groups were not statistically different in location of involvement (p = 0.12) or in the incidence of the target sign (p = 0.18). CONCLUSION: Although some of the CT features overlap, a short segment involvement with wall thickening of 1 cm or greater is typical of intramural hemorrhage; a long segment involvement with wall thickening of less than 1 cm is typical of ischemia
— id: 43879, year: 2003, vol: 180, page: 177, stat: Journal Article,

Evaluation of the small intestine by computed tomography
Balthazar EJ
Radiological imaging of the small intestine [S.l.] : Springer Verlag, 2002,
— id: 2790, year: 2002, vol: , page: 87, stat: Chapter,

Acute pancreatitis: assessment of severity with clinical and CT evaluation
Balthazar, Emil J
2002 Jun;223(3):603-613, Radiology
Treatment of patients with acute pancreatitis is based on the initial assessment of disease severity. Severe pancreatitis occurs in 20%-30% of all patients with acute pancreatitis and is characterized by a protracted clinical course, multiorgan failure, and pancreatic necrosis. Early staging is based on the presence and degree of systemic failure (cardiovascular, pulmonary, renal) and on the presence and extent of pancreatic necrosis. Individual laboratory indexes (markers of pancreatic injury, markers of inflammatory response), while promising, have not yet gained clinical acceptance. Numeric grading systems with sensitivities of about 70% are commonly used today as indicators of organ failure and disease severity. Contrast material-enhanced computed tomography is used in addition to help evaluate local pancreatic morphology and the presence and extent of pancreatic necrosis. Advantages and limitations of the clinical, laboratory, and imaging prognostic indexes are analyzed and discussed
— id: 43882, year: 2002, vol: 223, page: 603, stat: Journal Article,

Complications of acute pancreatitis: clinical and CT evaluation
Balthazar, Emil J
2002 Dec;40(6):1211-1227, Radiologic clinics of North America
Mortality of acute pancreatitis is dependent on the development of potentially lethal complications that can coexist and occur at any time following an acute attack. The nature and clinical relevance of these complications differ, contingent on the time of occurrence following a severe episode of pancreatitis. They can be divided into (1), early complications that manifest at the onset or within the first 2 to 3 days, (2) intermediate complications that occur predominantly during the second to fifth week, and (3) late complications that usually manifest months or years following the resolution of an acute attack. Early complications are systemic in nature with diverse clinical manifestations of the cardiovascular, pulmonary, renal, and/or metabolic systems. Intermediate complications are abdominal, pancreatic, and retroperitoneal, and are mostly septic in nature, associated with pancreatic or peripancreatic fat necrosis and pseudocysts. Late, life-threatening complications are mainly vascular or hemorrhagic in nature or involve the development of chronic pancreatic ascites. The early detection and objective evaluation of these complications by clinical and imaging methods leads to specific treatment options in the continuous attempt to decrease mortality rates in acute pancreatitis
— id: 43880, year: 2002, vol: 40, page: 1211, stat: Journal Article,

Staging of acute pancreatitis
Balthazar, Emil J
2002 Dec;40(6):1199-1209, Radiologic clinics of North America
Management of patients with acute pancreatitis is based on the early assessment of severity of disease. Initial staging is established on clinical and laboratory grounds and on the findings of contrast-enhanced CT imaging. Individual clinical parameters and laboratory indices, although sometimes helpful, are not sufficiently accurate to reliable assess the severity of an acute attack. Numerical grading systems (Ranson's, APACHE II) with sensitivities of about 70% are commonly used today as indicators of systemic failure and predictors of disease severity. Helical or MDCT scanning performed during the administration of a bolus of i.v. contrast material is performed to evaluate pancreatic morphology, detect pancreatic necrosis, and depict retroperitoneal complications. CT staging and the CT severity index have proved to be a reliable indicator of disease severity, having shown an excellent correlation with the risk of death and the development of local and systemic complications in this population
— id: 43881, year: 2002, vol: 40, page: 1199, stat: Journal Article,

Gastroduodenal mucosal prolapse: diagnosis using conventional abdominal radiographs
Lui, Yvonne W; Balthazar, Emil J
2002 May;178(5):1292-1293, American journal of roentgenology
— id: 43883, year: 2002, vol: 178, page: 1292, stat: Journal Article,

Mesenteric adenitis: CT diagnosis of primary versus secondary causes, incidence, and clinical significance in pediatric and adult patients
Macari, Michael; Hines, John; Balthazar, Emil; Megibow, Alec
2002 Apr;178(4):853-858, American journal of roentgenology
OBJECTIVE: Our objective was to determine the clinical significance of mesenteric adentitis when detected on CT. MATERIALS AND METHODS: Mesenteric adenitis was considered present if a cluster of three or more lymph nodes measuring 5 mm or greater each was present in the right lower quadrant mesentery. If no other abnormality was detected on CT, then mesenteric adenitis was considered primary. If a specific inflammatory process was detected in addition to the lymphadenopathy, then mesenteric adenitis was considered secondary. Patients with a known neoplasm or HIV infection were excluded. Three separate groups of patients were examined for the presence and cause of mesenteric adenitis. Group 1 consisted of 60 consecutive patients prospectively identified with mesenteric adenitis on CT examinations. Group 2 consisted of 60 consecutive patients undergoing abdominal and pelvic CT for evaluation of blunt or penetrating abdominal trauma. Group 3 consisted of 60 consecutive patients undergoing abdominal and pelvic CT with acute abdominal symptoms. In all patients, the indication for imaging was documented, and the size of the largest lymph node, when present, was measured. In patients with mesenteric adenitis, the CT findings, clinical history, and clinical or surgical follow-up were subsequently evaluated to determine the cause of mesenteric adenitis. RESULTS: In the 60 patients prospectively identified with CT findings of mesenteric adenitis (group 1), 18 (30%) of 60 had primary mesenteric adenitis. The remaining 42 patients (70%) had an associated inflammatory condition that was established on CT as the likely cause of mesenteric adenitis. Mesenteric adenitis was present in none (0%) of the 60 patients in group 2 and in five (8.3%) of 60 patients in group 3. CONCLUSION: The incidence of mesenteric adenitis in patients with and those without abdominal pain is low. When evidence of mesenteric adenitis is present on CT examinations, usually a specific diagnosis can be established as its cause
— id: 43661, year: 2002, vol: 178, page: 853, stat: Journal Article,

Hemorrhagic complications of pancreatitis: radiologic evaluation with emphasis on CT imaging
Balthazar EJ; Fisher LA
2001 ;1(4):306-313, Pancreatology
OBJECTIVE: To analyze and describe the incidence, pathophysiology, radiographic diagnosis and the initial management of hemorrhagic complications associated with pancreatitis. MATERIAL AND METHODS: Among 1,910 patients diagnosed of having pancreatitis in the last 10 years, 26 developed hemorrhagic complications (1.3%). These complications were detected from 2 months to 8 years after one or several episodes of pancreatitis with a mean of 2.3 years. Radiographic studies were reviewed and clinical management and outcome were recorded. RESULTS: Ten patients had CT evidence of pancreatic necrosis, 12 patients chronic pancreatitis, and 17 patients pancreatic pseudocysts. The cause of hemorrhage was bleeding pseudoaneurysm in 16 patients (61%), diffuse bleeding with pancreatic necrosis in 5 patients (19.5%) and hemorrhagic pseudocysts in 5 patients (19.5%). Intra-abdominal hemorrhage developed in 21 patients and gastro-intestinal bleeding in 5 patients. Arterial embolization was attempted in 12 patients and was successful in 9 patients (75%). Surgery was used in 16 patients and the overall mortality rate was 11%. CONCLUSIONS: Hemorrhagic complications are rarely seen and are usually late sequelae of pancreatitis. They develop because of leaking or ruptured pseudoaneurysms, diffuse bleeding in pancreatic necrosis, and hemorrhagic pseudocysts. Early detection followed by angiography, embolization and/or surgery has decreased mortality rates
— id: 32480, year: 2001, vol: 1, page: 306, stat: Journal Article,

Toxic megacolon: role of CT in evaluation and detection of complications
Imbriaco M; Balthazar EJ
2001 Sep-Oct;25(5):349-354, Clinical imaging
The purpose of this study is to determine the role of CT in the evaluation and in detecting complications in patients with toxic megacolon. A retrospective analysis of CT findings of 18 consecutive patients with toxic megacolon was performed. Underlying etiology included 12 patients with pseudomembranous colitis (PC), four patients with ulcerative colitis and two patients with cytomegalovirus colitis. Eleven patients were HIV+. CT features, correlation with severity of disease and development of complications were analyzed. Colonic dilatation with intraluminal air and/or fluid with a distorted colonic contour or an ahaustral pattern was seen in all patients. In four patients (22%), CT depicted complications-two colonic perforations and two septic thrombosis of the portal system. Six patients died (33%), three of whom had the above complications. The presence and degree of submucosal edema (accordion sign, target sign), wall thickening, degree of dilatation, nodular contour and ascites did not correlate with clinical outcome. Two thirds of patients with toxic megacolon had PC as the underlying etiology. CT was helpful in depicting diffuse colitis, and it was instrumental in detecting life-threatening abdominal complications, contributing to the management of these patients. CT abnormalities cannot be used to predict the clinical outcome unless complications develop
— id: 43884, year: 2001, vol: 25, page: 349, stat: Journal Article,

Ct of bowel wall thickening: significance and pitfalls of interpretation
Macari M; Balthazar EJ
2001 May;176(5):1105-1116, American journal of roentgenology
— id: 20728, year: 2001, vol: 176, page: 1105, stat: Journal Article,

Cystic pancreatic masses: cross-sectional imaging observations and serial follow-up
Megibow AJ; Lombardo FP; Guarise A; Carbognin G; Scholes J; Rofsky NM; Macari M; Balthazar EJ; Procacci C
2001 Nov-Dec;26(6):640-647, Abdominal imaging
BACKGROUND: We retrospectively reviewed the imaging features of a series of patients with cystic pancreatic masses, the majority of whom underwent imaging surveillance. METHODS: Imaging data from 30 patients with known cystic pancreatic masses were reviewed. Nine patients had surgical and/or cytologic classification. Of the 21 who were not operated on, all underwent serial imaging surveillance. Of these, five had corroborative endoscopic retrograde cholangiopancreatography and 16 were followed by only computed tomography and/or magnetic resonance imaging. RESULTS: In the nonoperated group, mean follow-up time was 30 months (3-144 months). Two patients demonstrated growth, and the remainder remain stable. In the patients who underwent surgery, invasive carcinoma was found in those with lesions larger than 4 cm, involvement of the main pancreatic duct, or visible solid components on the imaging study. Smaller lesions were benign. CONCLUSION: In patients with suspected cystic pancreatic neoplasms, surveillance might be possible if lesions are smaller than 2.5 cm, spare the main pancreatic duct, and demonstrate no solid components
— id: 32122, year: 2001, vol: 26, page: 640, stat: Journal Article,

Septic thrombophlebitis of the mesenteric and portal veins: CT imaging
Balthazar EJ; Gollapudi P
2000 Sep-Oct;24(5):755-760, Journal of computer assisted tomography
Pylephlebitis or septic thrombophlebitis of the portal vein and its tributaries is an acute ascending infection arising often from a primary gastrointestinal inflammatory lesion. Common primary sources of infection are diverticulitis, appendicitis, and infected pancreatic necrosis. CT imaging can diagnose this complication at an early stage and can significantly improve the previously reported high mortality and morbidity rates associated with this condition
— id: 43885, year: 2000, vol: 24, page: 755, stat: Journal Article,

Significance of minimal or no intraperitoneal fluid visible on CT scan associated with blunt liver and splenic injuries: a multicenter analysis
Ochsner MG; Knudson MM; Pachter HL; Hoyt DB; Cogbill TH; McAuley CE; Davis FE; Rogers S; Guth A; Garcia J; Lambert P; Thomson N; Evans S; Balthazar EJ; Casola G; Nigogosyan MA; Barr R
2000 Sep;49(3):505-510, Journal of trauma
BACKGROUND: The use of ultrasound (U/S) for the evaluation of patients with blunt abdominal trauma is gaining increasing acceptance. Patients who would have undergone computed tomographic (CT) scan may now be evaluated solely with U/S. Solid organ injuries with minimal or no free fluid may be missed by surgeon sonographers. OBJECTIVE: The purpose of this study was to describe the incidence and clinical importance of liver and splenic injuries with minimal or no free intraperitoneal fluid visible on CT scan. We hypothesized that these solid organ injuries occur infrequently and are of minor clinical significance. METHODS: Patient records and CT scans were reviewed for the presence of and outcome associated with blunt liver and splenic injuries with minimal (<250 mL) or no free fluid detected by an attending radiologist. Data were collected from six major trauma centers during a 4-year period before the introduction of U/S and included demographics, grade of injury (American Association for the Surgery of Trauma scale), need for operative intervention, and outcome. RESULTS: A total of 938 patients with liver and splenic injuries were identified. In this group, 11% of liver injuries and 12% of splenic injuries had no free fluid visible on CT scan and could be missed by diagnostic peritoneal lavage or U/S. Of the 938 patients, 267 (28%) met the inclusion criteria; 161 had injury to the spleen and 125 had injury to the liver. In the 267 patients studied, 97% of the injuries were managed nonoperatively. However, 8 patients (3%) required operative intervention for bleeding. Compared with the liver, the spleen was significantly more likely to bleed (p = 0.01), but the grade of splenic injury was not related to the risk for hemorrhage (p = 0.051). CONCLUSION: Data from this study suggest that injuries to the liver or spleen with minimal or no intraperitoneal fluid visible on CT scan occur more frequently than predicted but usually are of minimal clinical significance. However, patients with splenic injuries may be missed by abdominal U/S. We found a 5% associated risk of bleeding. Therefore, abdominal U/S should not be used as the sole diagnostic modality in all stable patients at risk for blunt abdominal injury
— id: 20061, year: 2000, vol: 49, page: 505, stat: Journal Article,

Ischemic colitis: CT evaluation of 54 cases
Balthazar EJ; Yen BC; Gordon RB
1999 May;211(2):381-388, Radiology
PURPOSE: To review the computed tomographic (CT) scans and medical records of 54 patients with proved ischemic colitis, define the spectrum of CT findings, and assess the effect of CT imaging on treatment. MATERIALS AND METHODS: The mean age of the patients was 72 years. CT scans were analyzed for the presence of colonic abnormalities and associated findings. Ischemia was clinically unsuspected in 16 patients (30%). RESULTS: Segmental involvement was seen in 48 patients (89%), with a mean length of involvement of 19 cm (range, 5-38 cm). Wall thickness varied between 2 and 20 mm (mean, 8 mm). All parts of the colon were involved. The CT appearance of the colonic wall varied: (a) A wet appearance with heterogeneous areas of edema was seen in 33 patients (61%). (b) A dry appearance with mild homogeneous thickening was seen in 18 patients (33%). (c) Intramural air was present in three patients (6%). Ischemia resolved in 41 patients (76%), and complications occurred in 13 patients (24%). CONCLUSION: CT can be used to confirm the clinical suspicion of ischemic colitis, to suggest ischemia when it is unsuspected, and to diagnose complications. Intrinsic colonic abnormalities cannot be used to diagnose or predict the development of infarction
— id: 6110, year: 1999, vol: 211, page: 381, stat: Journal Article,

The accordion sign at CT: a nonspecific finding in patients with colonic edema
Macari M; Balthazar EJ; Megibow AJ
1999 Jun;211(3):743-746, Radiology
PURPOSE: To determine whether the 'accordion sign' is a specific computed tomographic (CT) sign of Clostridium difficile colitis. MATERIALS AND METHODS: Fifty-seven patients with CT evidence of severe colitis, as judged by colonic wall thickening, an abnormal haustral pattern, the target sign, and stranding of the pericolic fat, were identified from a computerized CT database for 25 months. CT images were retrospectively evaluated for the presence of oral contrast material in the colon and for the accordion sign. The medical and laboratory records of all patients were reviewed and correlated with CT findings to establish the cause of colitis. RESULTS: Oral contrast material had reached the colon in 35 of 57 patients at the time of the CT examination. The images in 15 of these patients demonstrated the accordion sign, and those in 20 patients did not. C difficile colitis was documented in four of the 15 cases displaying the accordion sign. In the remaining 11 patients, a different cause was documented. Oral contrast material had not reached the colon in the remaining 22 patients. Within this group with findings similar to the accordion sign, five patients had documented C difficile colitis, and four had colitis from other causes. CONCLUSION: The accordion sign is indicative of severe colonic edema or inflammation, but it is not specific for C difficile colitis
— id: 6127, year: 1999, vol: 211, page: 743, stat: Journal Article,

Appendicitis: the impact of computed tomography imaging on negative appendectomy and perforation rates
Balthazar EJ; Rofsky NM; Zucker R
1998 May;93(5):768-771, American journal of gastroenterology
OBJECTIVES: The purposes of this study were to investigate the use of computed tomography (CT) imaging in patients with suspected acute appendicitis and to evaluate the impact of CT on negative appendectomy and perforation rates. In patients clinically diagnosed of acute appendicitis the reported overall negative appendectomy rate is about 15-20%; 10% in men and 25-45% in women of childbearing age. This is associated with a perforation rate of 21-23%. METHODS: This is a retrospective analysis of 146 consecutive patients presenting with clinical symptoms suspicious of appendicitis over a 2-yr period in whom CT examinations were performed before therapy was instituted. The overall negative appendectomy and perforation rates were calculated for the entire group, as well as for the 54 women aged 15-50 yr in the childbearing cohort. RESULTS: The negative appendectomy rate was 4% in 122 patients operated on and the perforation rate was 22%. Among 36 women 15-50 yr of age operated on, the negative appendectomy rate was 8.3% and the perforation rate was 19%. Surgery was avoided in 24 patients, 18 of whom were women of childbearing age. CONCLUSIONS: The judicious use of CT imaging in patients with equivocal clinical presentation suspected of having appendicitis led to a significant improvement in the preoperative diagnosis. It resulted in a substantial decrease in the negative appendectomy rate compared to previously published reports, without incurring an increase in the perforation rate
— id: 12111, year: 1998, vol: 93, page: 768, stat: Journal Article,

CT diagnosis of ileal diverticulitis
Macari M; Balthazar EJ; Krinsky G; Cao H
1998 Jul-Aug;22(4):243-245, Clinical imaging
The preoperative diagnosis of ileal diverticulitis has been reported during small-bowel series when inflammatory changes are associated with ileal diverticula. Previous CT reports of this entity have failed to establish the specific diagnosis preoperatively. We report the CT findings in a patient with right lower quadrant pain that enabled the specific diagnosis of ileal diverticulitis to be made
— id: 7667, year: 1998, vol: 22, page: 243, stat: Journal Article,

Intestinal ischemia in patients in whom small bowel obstruction is suspected: evaluation of accuracy, limitations, and clinical implications of CT in diagnosis
Balthazar EJ; Liebeskind ME; Macari M
1997 Nov;205(2):519-522, Radiology
PURPOSE: To determine the accuracy of computed tomography (CT) in diagnosis of intestinal ischemia in patients with possible intestinal obstruction and the limitations and clinical implications of use of CT. MATERIALS AND METHODS: In 100 patients in whom intestinal obstruction was suspected clinically, CT findings were correlated with surgical findings in 77 patients and with follow-up clinical findings after nasogastric suction in 23 patients. The interval between CT and surgical exploration in patients with ischemic bowel was 1-98 hours (mean, 13 hours). RESULTS: Correlation of CT findings of strangulation obstruction with surgical findings revealed 72 true-negative, 19 true-positive, five false-positive, and four false-negative CT results. Sensitivity was 83%, specificity was 93%, accuracy was 91%, positive predictive value was 79%, and negative predictive value was 95%. CONCLUSION: CT enables accurate detection of bowel ischemia, particularly when small bowel obstruction is present. Exploratory laparotomy should be performed when unexplained disparities exist between equivocal CT findings and a deteriorating clinical condition in patients with possible small bowel obstruction or mesenteric infarction
— id: 12235, year: 1997, vol: 205, page: 519, stat: Journal Article,

CT of small-bowel lymphoma in immunocompetent patients and patients with AIDS: comparison of findings
Balthazar EJ; Noordhoorn M; Megibow AJ; Gordon RB
1997 Mar;168(3):675-680, American journal of roentgenology
OBJECTIVE: The purpose of this study was to describe and analyze the CT features of small-bowel lymphoma, compare those features with the radiographic presentation in immunocompetent patients and patients with AIDS, and discuss the role of CT in the initial detection and evaluation of this disease. MATERIALS AND METHODS: Abdominal CT examinations of 42 consecutive patients with proven small-bowel lymphoma were retrospectively reviewed. In 19 patients, small-bowel examinations were also available for review. The 42-patient study group was divided into two subgroups: 22 patients with AIDS and 20 immunocompetent patients. RESULTS: Primary small-bowel lymphoma was present in 37% of patients and was equally distributed between the two subgroups. The histologic types included non-Hodgkin's lymphoma in 33 patients, Burkitt's lymphoma in seven patients, Hodgkin's lymphoma in one patient, and mucosa-associated lymphoid tissue-type lymphoma in one patient. Solid organ involvement (liver, splee, kidney, or adrenal glands) was detected in 22% of patients with AIDS and in 10% of the immunocompetent patients. We saw two main patterns of CT appearance. In the first pattern, single or multiple segments had circumferential wall thickening, homogeneous in attenuation, that ranged from 1.5 cm to 7 cm (mean, 2.6 cm) in 33 patients. In the second pattern, single or multiple cavitary lesions were revealed as nodular and grossly enlarged intestinal lumen with bowel wall thickening in 13 patients. A polypoid mass that was entirely intraluminal was seen in one patient. Heterogeneous areas of low attenuation were revealed in two intestinal tumors of HIV-positive patients. Mesenteric or retroperitoneal lymphadenopathy was seen in 45% of patients with AIDS and 60% of the immunocompetent patients. The gross morphologic features, distribution. pattern of CT presentation, degree of wall thickening, and length of involvement were all similar in the two subgroups. CONCLUSION: More than half (52%) of the individuals with small-bowel lymphoma diagnosed at our institution in the last 4 years were patients with AIDS. The features revealed by CT scans were characteristic or highly suggestive of small-bowel lymphoma. We saw no significant differences in the radiographic features of patients with AIDS and immunocompetent patients
— id: 12374, year: 1997, vol: 168, page: 675, stat: Journal Article,

The role of radiology in the diagnosis of small-bowel obstruction
Maglinte DD; Balthazar EJ; Kelvin FM; Megibow AJ
1997 May;168(5):1171-1180, American journal of roentgenology
— id: 43682, year: 1997, vol: 168, page: 1171, stat: Journal Article,

Salmonella- and Shigella-induced ileitis: CT findings in four patients
Balthazar EJ; Charles HW; Megibow AJ
1996 May-Jun;20(3):375-378, Journal of computer assisted tomography
PURPOSE: The purpose of this study is to describe and illustrate the CT appearance of four cases of acute terminal ileitis induced by nontyphoidal Salmonella and Shigella infection and to review the radiographic and endoscopic findings of these entities. METHOD: The medical records, CT examinations, and small bowel examinations of three patients with Salmonella ileitis and one patient with Shigella ileitis were retrospectively reviewed. CT examinations were done in four patients, colonoscopy in three patients, and small bowel examinations in two patients. Stool cultures established the diagnosis of nontyphoidal Salmonella enteritis in three patients and Shigella enteritis in one patient. The patients' symptoms and clinical findings resolved promptly following supportive therapy and appropriate antibiotic therapy. RESULTS: CT showed slight circumferential and homogeneous thickening of the terminal ileum over a segment of 10-15 cm in patients with Salmonella ileitis. Associated mild thickening of the wall of the colon was present in addition. Small bowel examination performed in one patient revealed a spastic terminal ileum with thickened mucosal folds. Colonoscopy revealed acute colitis involving the colon diffusely in one case, but sparing the distal 50 cm of the colon in one case. CT showed more pronounced thickening of the terminal ileum and a target configuration in the patient with Shigella ileitis. Small bowel examination revealed narrowing, irregular contour, several large nodular defects (thumbprinting), and a severely ulcerated mucosa affecting the terminal ileum. Colonoscopy revealed a normal colon and large ulcerations with fibropurulent exudate in the terminal ileum. CONCLUSION: In patients with severe Salmonella or Shigella infections or persistent and/or confusing clinical presentations, CT can play a complementary but important role in the initial diagnostic evaluation. It avoids clinical mismanagement, circumvents unnecessary invasive procedures, and contributes to the efficient workup and therapy in this group of individuals
— id: 6979, year: 1996, vol: 20, page: 375, stat: Journal Article,

Giant ulcers in the ileum and colon caused by cytomegalovirus in patients with AIDS
Balthazar EJ; Martino JM
1996 Jun;166(6):1275-1276, American journal of roentgenology
— id: 8049, year: 1996, vol: 166, page: 1275, stat: Journal Article,

CT evaluation of infradiaphragmatic air in patients treated with mechanically assisted ventilation: a potential source of error
Balthazar EJ; Moore SL
1996 Sep;167(3):731-734, American journal of roentgenology
OBJECTIVE: The purpose of this study was to describe the CT features of infradiaphragmatic air that may develop in patients after mechanically assisted ventilation, its location, its pathway of transdiaphragmatic dissection, and its extension into the abdomen. MATERIALS AND METHODS: We retrospectively evaluated six consecutive adult patients with pneumomediastinum associated with positive end-expiratory pressure therapy who developed intraabdominal air and were imaged with CT in our institution-between 1993 and 1995. Abdominal CT examinations were reviewed and correlated with the clinical findings, follow-up examinations, and exploratory laparotomies in four patients. RESULTS: In four patients, air present in the anterior mediastinum (endothoracic fascia) was seen to extend into the anterior abdominal wall within the extraperitoneal space. In a fifth patient, the air was located extraperitoneally and intraperitoneally. In the remaining patient, air was present exclusively in the peritoneal cavity. In only two patients did we detect small amounts of air in the posterior retroperitoneum. In five patients, we also detected subcutaneous emphysema and/or air dissection into the muscle planes of the anterolateral abdominal wall. CONCLUSION: In patients on mechanically assisted ventilation, anterior mediastinal air can dissect through the diaphragm into the anterior abdominal extraperitoneal space. This anterior pathway of infradiaphragmatic extension of air can be erroneously diagnosed as intraperitoneal air, which may lead to unnecessary exploratory laparotomies. Also, anterior mediastinal air can enter the peritoneal cavity, particularly in patients with a history of median sternotomy
— id: 8050, year: 1996, vol: 167, page: 731, stat: Journal Article,

CT features of ulcerative colitis and Crohn's disease
Gore RM; Balthazar EJ; Ghahremani GG; Miller FH
1996 Jul;167(1):3-15, American journal of roentgenology
— id: 43886, year: 1996, vol: 167, page: 3, stat: Journal Article,

CT in patients with scirrhous carcinoma of the GI tract: imaging findings and value for tumor detection and staging [see comments]
Balthazar EJ; Siegel SE; Megibow AJ; Scholes J; Gordon R
1995 Oct;165(4):839-845, American journal of roentgenology
OBJECTIVE. The purposes of this study were to analyze the CT features of scirrhous carcinoma of the gastrointestinal (GI) tract and to assess the usefulness of CT in detecting and staging these lesions. MATERIAL AND METHODS. This is a retrospective evaluation of 31 proven cases of scirrhous carcinoma (linitis plastica) of the GI tract imaged in our institution from 1986 to 1994. Twenty-two patients had primary gastric carcinoma, and nine had carcinoma of the colon (rectosigmoid in eight and right colon in one). CT examinations were reviewed and correlated with pathologic and/or surgical findings in all patients and with barium examinations in 19 cases. A modified Dukes classification was used to stage these lesions without knowledge of the pathologic and surgical results. RESULTS. Four gastric lesions were missed during the initial CT examination. Seventeen patients had extensive circumferential lesions, and five had focal plaquelike lesions. The wall thickness ranged from 1 to 3 cm (mean, 1.8 cm). Homogeneous enhancement was seen in 17 patients, slightly heterogeneous enhancement was seen in one, a target configuration was present in two patients, and intramural calcification was present in one patient. All colonic lesions were circumferential, homogeneously enhancing with a wall thickness ranging from 1 to 3 cm (mean, 2 cm). CT scans showed limitations in evaluating local parameters. Compared with surgical and pathologic staging, CT correctly staged 26 patients, understaged four patients, and overstaged one patient. Among the 19 patients with pathologically proven stage D lesions (61%), CT correctly staged 17 patients (89%) and had a 100% positive predictive value. One case of hepatic metastases, 13 cases of malignant ascites, and 11 cases of omental and peritoneal metastases were found. CONCLUSION. CT is an important complimentary imaging technique to detect scirrhous carcinoma. The sensitivity of detection depends on the size of the lesion and the quality of the examination. CT has limitations in staging early lesions but shows a high sensitivity (89%) in detecting Dukes stage D lesions. Accurate CT staging in these individuals (61% in this series) allows a more adequate treatment strategy and avoids unnecessary exploratory laparotomies
— id: 6804, year: 1995, vol: 165, page: 839, stat: Journal Article,

For suspected small-bowel obstruction and an equivocal plain film, should we perform CT or a small-bowel series?
Balthazar EJ
1994 Nov;163(5):1260-1261, American journal of roentgenology
— id: 12866, year: 1994, vol: 163, page: 1260, stat: Journal Article,

George W. Holmes Lecture. CT of small-bowel obstruction
Balthazar EJ
1994 Feb;162(2):255-261, American journal of roentgenology
The diagnosis of intestinal obstruction is established or suspected on clinical grounds, and it is usually confirmed with plain abdominal radiography. Because of significant limitations in the clinical and initial radiographic evaluations, antegrade or retrograde contrast-enhancement (barium, water-soluble media) studies are being additionally requested for about 20-30% of patients [1-6]. In the past few years, the steady advances in technology, technique, and interpretation have increased the value of CT in diagnosing and evaluating intestinal obstruction [7-10]. Although the precise role and contribution of CT are still being investigated and remain controversial, its significant clinical impact is already generally accepted. For patients thought to have mechanical intestinal obstruction who have confusing clinical and conventional radiographic findings, CT is currently used as a complementary imaging study, in direct competition with the more traditional gastrointestinal contrast-enhanced examinations generally used. The potential contribution of CT and its role, advantages, and limitations in the diagnosis and evaluation of intestinal obstruction are explored
— id: 6315, year: 1994, vol: 162, page: 255, stat: Journal Article,

Acute appendicitis: CT and US correlation in 100 patients
Balthazar EJ; Birnbaum BA; Yee J; Megibow AJ; Roshkow J; Gray C
1994 Jan;190(1):31-35, Radiology
PURPOSE: To compare the accuracy of computed tomography (CT) and ultrasonography (US) in the diagnosis of acute appendicitis. MATERIALS AND METHODS: One hundred consecutive patients were examined with US and CT, and the results, independently reported, were correlated with surgical and histopathologic findings (69 patients) and data from other laboratory and clinical follow-up (31 patients). RESULTS: Fifty-four patients had acute appendicitis; 46 patients did not. Analysis of the data for CT and US, respectively, revealed sensitivity, 96% versus 76%; specificity, 89% versus 91%; accuracy, 94% versus 83%; positive predictive value, 96% versus 95%; and negative predictive value, 95% versus 76%. In the 46 patients without appendicitis, an alternative diagnosis was made with CT in 22 patients and with US in 15. CT scans showed abscesses and/or phlegmons in 28% of patients with appendicitis versus 17% at US. Results of CT and US were discordant in 20 patients; CT findings were correct in 17 and US findings in three. CONCLUSION: CT is more accurate than US in diagnosis of acute appendicitis
— id: 6316, year: 1994, vol: 190, page: 31, stat: Journal Article,

Contrast-enhanced computed tomography in acute pancreatitis: is it beneficial or harmful?
Balthazar EJ; Freeny PC
1994 Jan;106(1):259-262, Gastroenterology
— id: 43888, year: 1994, vol: 106, page: 259, stat: Journal Article,

Imaging and intervention in acute pancreatitis
Balthazar EJ; Freeny PC; vanSonnenberg E
1994 Nov;193(2):297-306, Radiology
An International Symposium was held in Atlanta in 1992 to present the state of the art of diagnostic evaluation and management of acute pancreatitis and to agree on an acceptable series of clinical definitions for classifying the disease and its complications. The symposium was composed of 40 internationally recognized experts in pancreatic disease from 15 countries representing six disciplines (anatomy, gastroenterology, internal medicine, pathology, radiology, and surgery). The purpose of this article is to present the radiologically relevant aspects of the symposium; to define the state of the art of imaging and intervention in acute pancreatitis, particularly how and when to use computed tomography and how and when to perform percutaneous therapy versus surgery; and to encourage radiologists to use precise and proper nomenclature when describing the morphologic manifestations of acute pancreatitis as depicted by various imaging modalities
— id: 12868, year: 1994, vol: 193, page: 297, stat: Journal Article,

Necrotizing Candida enterocolitis in AIDS: CT features
Balthazar EJ; Stern J
1994 Mar-Apr;18(2):298-300, Journal of computer assisted tomography
An unusual case of necrotizing enterocolitis secondary to invasive candidiasis in acquired immunodeficiency syndrome is reported. Computed tomography showed significant small bowel dilatation, high density intestinal contents, extensive ileal pneumatosis intestinalis, and air in the intrahepatic branches of the portal vein. Mucosal ulcerations and extensive transmural necrosis associated with invasive candidiasis were detected in the distal ileum and right colon in the resected pathology specimen
— id: 6314, year: 1994, vol: 18, page: 298, stat: Journal Article,

IMAGING THE ACUTE ABDOMEN - PREFACE
BALTHAZAR, EJ
1994 SEP ;32(5):R11-R12, Radiologic clinics of North America
— id: 52366, year: 1994, vol: 32, page: R11, stat: Journal Article,

Imaging the acute abdomen
Balthazar, Emil J
Philadelphia : W.B. Saunders, 1994,
— id: 594, year: 1994, vol: , page: , stat: ,

CT of appendicitis and diverticulitis
Birnbaum BA; Balthazar EJ
1994 Sep;32(5):885-898, Radiologic clinics of North America
CT scans have made a significant impact on the diagnosis and staging of those gastrointestinal disorders that are associated with perienteric inflammatory extension. Appendicitis and diverticulitis are examples of such diseases, and this article reviews the current role of CT scans in the diagnosis and management of patients with these conditions
— id: 43887, year: 1994, vol: 32, page: 885, stat: Journal Article,

Acute cholangitis: CT evaluation
Balthazar EJ; Birnbaum BA; Naidich M
1993 Mar-Apr;17(2):283-289, Journal of computer assisted tomography
The CT findings of 23 patients with proven acute ascending cholangitis were retrospectively evaluated. Computed tomography confirmed the clinical diagnosis and detected the site and etiology of the obstructive process in the majority of patients. Biliary dilatation consistent with the clinical suspicion of acute cholangitis was present in 18 patients (78%), the level of the obstruction was detected in 15 patients, and the etiology of the obstructive process was visualized in 14 cases. Five patients presented with air in the biliary tree and three patients had liver abscesses. There was no good correlation established between jaundice, biliary infection, and the presence or degree of biliary dilatation. Biliary obstruction and acute cholangitis can develop before biliary dilatation is detected. In addition, CT showed limitations in establishing the etiology of the obstructive process, particularly in failing to detect 7 of 17 cases of cholesterol biliary stones
— id: 13226, year: 1993, vol: 17, page: 283, stat: Journal Article,

CT of Clonorchis Sinensis pancreatitis
Balthazar EJ; Lamb T
1993 Oct;14(2):189-194, International journal of pancreatology
Clonorchis Sinensis infestation can involve the pancreatic duct and induce attacks of acute pancreatitis. Ct findings in a case of Clonorchis Sinensis pancreatitis revealed significant enlargement of the pancreas with compression and obstruction of the common duct. Medical treatment leads to resolution of the clinical and CT findings. The patient experienced a second episode of pancreatitis 3 yr later. CT examination documented the development of chronic pancreatitis with an acute exacerbation
— id: 6313, year: 1993, vol: 14, page: 189, stat: Journal Article,

Left-sided omental infarction with associated omental abscess: CT diagnosis
Balthazar EJ; Lefkowitz RA
1993 May-Jun;17(3):379-381, Journal of computer assisted tomography
The CT findings of two patients with left-sided omental infarction associated with acute inflammation and abscess formation are described and illustrated. The patients presented with lower abdominal pain, fever, and leukocytosis, and they exhibited a poorly defined heterogeneous low-attenuated mass containing fat in the anterior left lower abdomen. Although segmental omental infarction is usually a self-limiting condition that may resolve spontaneously, necrosis associated with secondary infection and abscess formation may develop occasionally
— id: 13167, year: 1993, vol: 17, page: 379, stat: Journal Article,

Histoplasmosis of the colon in patients with AIDS: imaging findings in four cases
Balthazar EJ; Megibow AJ; Barry M; Opulencia JF
1993 Sep;161(3):585-587, American journal of roentgenology
OBJECTIVE. The purpose of this study was to describe and illustrate the radiographic findings of colonic histoplasmosis in patients with AIDS. SUBJECTS AND METHODS. Four HIV-positive patients were admitted because of fever, abdominal pain, tenderness, weight loss, and diarrhea. One patient had known disseminated histoplasmosis, one had esophageal moniliasis, and two had no other known opportunistic infections or tumors. All four patients had barium enemas, and two had abdominal CT examinations. The diagnosis was established via colonoscopic biopsy in three patients and with surgery in one patient. RESULTS. Barium enema in two patients showed separate, short, apple-core lesions in the transverse and descending colon. In one patient, a single lesion in the ascending colon mimicked colonic carcinoma. One patient had segmental involvement of the ascending colon, compatible with inflammatory bowel disease. CT examination revealed circumferential thickening of the wall of the colon with adjacent lymphadenopathy of mixed attenuation. Three patients responded to medical therapy, and one patient remained symptomatic and was found on a follow-up CT examination to have significant recurrence of retroperitoneal lymphadenopathy. CONCLUSION. Colonic histoplasmosis in patients with AIDS has protean radiographic features and can mimic colonic carcinoma. In these patients, histoplasmosis should be part of the differential diagnosis, particularly when several colonic lesions are detected, associated regional and retroperitoneal lymphadenopathy is present, and the patient is living or has lived in an endemic area
— id: 13080, year: 1993, vol: 161, page: 585, stat: Journal Article,

Closed-loop and strangulating intestinal obstruction: CT signs [see comments]
Balthazar EJ; Birnbaum BA; Megibow AJ; Gordon RB; Whelan CA; Hulnick DH
1992 Dec;185(3):769-775, Radiology
In 19 patients with closed-loop intestinal obstruction, including 16 patients with strangulating obstruction, the findings at examination with computed tomography (CT) were retrospectively correlated with the surgical and pathologic findings and evaluated by two radiologists. Signs of closed-loop obstruction, present in 15 patients, were associated with the configuration of the incarcerated loop of small bowel, abnormalities detected at the site of obstruction, or both. These abnormalities were the following: a U-shaped, distended, fluid-filled bowel loop; the whirl sign; the beak sign; a triangular loop; two adjacent collapsed loops of bowel at the site of obstruction; or all of these. CT signs of strangulation, seen in 10 of the 16 patients with ischemic or infarcted bowel, were associated with the appearance of the bowel wall (thickening, high attenuation, and the target sign), abnormalities in the attached mesentery, or both. In mechanical obstruction of the small bowel, detection of ischemic changes in the bowel wall or mesentery with CT indicates strangulation. Absence of CT findings of ischemia or infarction does not rule out strangulation
— id: 13358, year: 1992, vol: 185, page: 769, stat: Journal Article,

Pancreatic inflammatory disease : diagnosis, staging, and intervention
Balthazar EJ; Freeny PC
[Oak Brook IL] : Radiological Society of North America, 1992,
— id: 778, year: 1992, vol: , page: , stat: ,

Cytomegalovirus gastritis: protean radiologic features
Farman J; Lerner ME; Ng C; Balthazar E; Megibow A; Herlinger H; Grimes M
1992 Summer;17(3):202-206, Gastrointestinal radiology
Infection with cytomegalovirus (CMV) is a major feature of acquired immunodeficiency syndrome (AIDS). Gastrointestinal involvement is being seen more frequently. Our collective experience involves nine patients with stomach involvement. Seven patients were intravenous drug abusers or homosexuals with AIDS. One developed CMV gastritis as a complication of leukemia and one patient was a West African with lymphoma and human immunodeficiency virus (HIV) infection. All our patients had biopsy-proven CMV inclusion bodies. The radiographic appearances varied widely. The findings included markedly thickened edematous folds, erosive gastritis with aphthous ulceration, and superficial and deep ulceration. One patient had deep ulceration with fistula formation. Computed tomographic (CT) scans confirmed the greatly thickened gastric wall and coarsened folds in two patients. Associated gastrointestinal infections included candida and herpes, and, in addition, pneumocystis carinii pneumonia (PCP) was present in two patients. CMV gastritis may mimic several other conditions including erosive gastritis, peptic ulceration, lymphoma, and carcinoma. It should be strongly considered in immunosuppressed patients
— id: 43685, year: 1992, vol: 17, page: 202, stat: Journal Article,

CT of the gastrointestinal tract: principles and interpretation
Balthazar EJ
1991 Jan;156(1):23-32, American journal of roentgenology
The experience accumulated in daily abdominal CT scanning and CT evaluation of gastrointestinal lesions has generated helpful technical guidelines and some reliable principles of interpretation. These general principles are briefly discussed in this review, and the importance of performing a CT examination that is adequate for the detection and evaluation of gastrointestinal lesions is stressed. CT features useful in differentiating benign from malignant lesions, limitations and pitfalls in CT interpretation, overlap in the CT appearance, and classical CT features leading to specific diagnoses are described and illustrated. Although CT is established as one of the most important techniques for imaging the gastrointestinal tract, it should be used selectively and only in the context of appropriate clinical and conventional radiologic examination. CT should not be regarded as competing with, but as complementing, barium examination of the gastrointestinal tract
— id: 14191, year: 1991, vol: 156, page: 23, stat: Journal Article,

Appendicitis: prospective evaluation with high-resolution CT
Balthazar EJ; Megibow AJ; Siegel SE; Birnbaum BA
1991 Jul;180(1):21-24, Radiology
Computed tomography (CT) was used to prospectively evaluate 100 patients with clinical indications for acute appendicitis. Examinations were performed with the terminal ileum and cecum filled with contrast material. Acute appendicitis was diagnosed when an abnormal appendix or inflammatory changes plus an appendicolith were detected. Failure to visualize an abnormal appendix or appendicolith in the presence of pericecal inflammatory changes was considered suspicious but nonspecific. CT results were correlated with surgical and pathologic results (74 patients) and other radiologic and clinical findings (26 patients). CT helped to diagnose appendicitis (64 patients) and nonspecific right lower quadrant inflammation (five patients) and to rule out appendicitis (31 patients). CT had a 98% sensitivity, an 83% specificity, and a 93% accuracy. In 17 of 31 patients without CT evidence of appendicitis, other conditions explaining their symptoms were detected. When the clinical diagnosis is in doubt, CT can be used successfully to evaluate patients with acute appendicitis
— id: 43686, year: 1991, vol: 180, page: 21, stat: Journal Article,

Bowel obstruction: evaluation with CT [see comments]
Megibow AJ; Balthazar EJ; Cho KC; Medwid SW; Birnbaum BA; Noz ME
1991 Aug;180(2):313-318, Radiology
Eighty-four computed tomographic (CT) scans from patients referred for bowel obstruction between January 2, 1988, and December 31, 1989, were retrospectively evaluated. A pair of radiologists without knowledge of patient histories determined the presence or absence of bowel obstruction. Sixty-four patients ultimately proved to have intestinal obstruction, and 20 did not. Diagnosis was established by means of surgery (n = 39), barium studies (n = 17), and clinical course (n = 28). Causes of obstruction included adhesions (n = 37), metastases (n = 6), primary tumor (n = 7), Crohn disease (n = 4), hernia (n = 3), hematoma (n = 2), colonic diverticulitis (n = 2), and other (n = 3). In addition, 83 CT examinations in patients with no history or indication of intestinal obstruction were simultaneously reviewed. The overall sensitivity was 94%, specificity was 96%, and accuracy was 95%. The cause of obstruction was correctly predicted in 47 of 64 cases (73%). Intestinal obstruction was not diagnosed in any of the 83 control patients. CT is most useful in patients with a history of abdominal malignancy and in patients who have not been operated on and who have signs of infection, bowel infarction, or a palpable abdominal mass
— id: 13943, year: 1991, vol: 180, page: 313, stat: Journal Article,

Computed tomography of pancreatic masses
Balthazar EJ; Chako AC
1990 Apr;85(4):343-349, American journal of gastroenterology
High resolution sequential bolus dynamic computed tomography (CT) has become the modality of choice for the diagnosis, evaluation, and staging of pancreatic masses. The reliable visualization of the pancreatic gland by CT allows detection of small pancreatic masses, as well as accurate morphologic characterization and preoperative staging. Although CT has proven to be the most accurate imaging modality for the detection and diagnosis of pancreatic masses, the presumptive pathologic diagnosis should always be confirmed by appropriate biopsy and histologic examination. The other imaging modalities now play a secondary or accessory role, and are used mainly when the CT examination is equivocal or nondiagnostic
— id: 43889, year: 1990, vol: 85, page: 343, stat: Journal Article,

Computerized tomography in acute gastrointestinal disorders
Balthazar EJ; Chako AC
1990 Nov;85(11):1445-1452, American journal of gastroenterology
In recent years, computerized tomography (CT) has become one of the most important imaging modalities in evaluation of patients with acute gastrointestinal disorders. Its role, diagnostic accuracy, indications, and limitations in some of the most commonly encountered acute abdominal conditions are succinctly presented and reviewed. CT should not be used indiscriminantly, but is best considered a valuable primary or complimentary diagnostic tool in critically ill patients. Its selective use in a variety of emergency abdominal diseases will significantly improve accuracy of clinical diagnoses, leading to a prompt and adequate medical or surgical management
— id: 14288, year: 1990, vol: 85, page: 1445, stat: Journal Article,

Ileocecal tuberculosis: CT and radiologic evaluation
Balthazar EJ; Gordon R; Hulnick D
1990 Mar;154(3):499-503, American journal of roentgenology
The CT and radiologic findings in 11 patients (five with AIDS and six without AIDS) with ileocecal tuberculosis are described. On CT scans, five cases showed mild circumferential wall thickening of the terminal ileum and cecum, thickening of the ileocecal valve, and a few regional nodes. One case presented as nonspecific small-bowel obstruction. In five patients a more characteristic CT appearance was detected: preferential thickening of the ileocecal valve and medial wall of the cecum, exophytic extension engulfing the terminal ileum, and massive lymphadenopathy with low-density areas consistent with caseation necrosis. Patients with AIDS had a more severe form of involvement than those who did not have AIDS. Barium studies showed ileocecal changes consistent with an inflammatory process. In conjunction with barium enema, CT is helpful in the initial evaluation of ileocecal tuberculosis, showing the location and extent of intestinal and mesenteric involvement in most cases. Characteristic CT findings are seen when the inflammatory process is severe
— id: 43890, year: 1990, vol: 154, page: 499, stat: Journal Article,

Limitations in the CT diagnosis of acute diverticulitis: comparison of CT, contrast enema, and pathologic findings in 16 patients
Balthazar EJ; Megibow A; Schinella RA; Gordon R
1990 Feb;154(2):281-285, American journal of roentgenology
Pitfalls in CT diagnosis of acute diverticulitis were investigated in 16 patients with the disease who had misleading or equivocal CT features. The CT appearance was correlated with contrast enemas (13 cases) and with surgical assessment and pathologic evaluation of resected specimens (12 cases). Limitations in the CT diagnosis were related to (1) marked thickening of the colonic wall, between 1 and 3 cm in cross section simulating colonic neoplasm (all patients); (2) inability to visualize small amounts of fibropurulent exudate in the absence of pericolic inflammatory changes (eight patients); (3) failure to detect discrete intramural abscess (five patients). Resected surgical specimens available in 12 cases proved that colonic wall thickening was caused by muscular hypertrophy and various degrees of submucosal inflammation, edema, fibrosis, or focal organized inflammatory tissue. Contrast enema was useful in 10 out of 13 patients by excluding carcinoma of the colon and confirming the diagnosis of acute diverticulitis
— id: 43692, year: 1990, vol: 154, page: 281, stat: Journal Article,

Acute pancreatitis: value of CT in establishing prognosis
Balthazar EJ; Robinson DL; Megibow AJ; Ranson JH
1990 Feb;174(2):331-336, Radiology
The presence and degree of pancreatic necrosis (30%, 50%, or greater than 50%) was evaluated by means of bolus injection of contrast material and dynamic sequential computed tomography (CT) in 88 patients with acute pancreatitis at initial and follow-up examinations. Pancreatic necrosis was defined as lack of enhancement of all or a portion of the gland. Length of hospitalization, morbidity, and mortality in patients with early or late necrosis (22 patients) were evaluated and compared with the same criteria in the rest of the group. Patients with necrosis had a 23% mortality and an 82% complication rate; patients without necrosis had 0% mortality and 6% morbidity. When only the initial assessment was considered, patients with peripancreatic phlegmons and necrosis had 80% morbidity, compared with 36% morbidity in those with phlegmons and no necrosis. Serious complications occurred in patients who initially had or developed more than 30% necrosis. A CT severity index, based on a combination of peripancreatic inflammation, phlegmon, and degree of pancreatic necrosis as seen at initial CT study, was developed. Patients with a high CT severity index had 92% morbidity and 17% mortality; patients with a low CT severity index had 2% morbidity, and none died
— id: 43690, year: 1990, vol: 174, page: 331, stat: Journal Article,

Extrapulmonary Pneumocystis carinii infection in AIDS: CT findings
Lubat E; Megibow AJ; Balthazar EJ; Goldenberg AS; Birnbaum BA; Bosniak MA
1990 Jan;174(1):157-160, Radiology
Clinical and computed tomographic (CT) findings in three cases of extrapulmonary Pneumocystis carinii infection in patients with acquired immunodeficiency syndrome (AIDS) were reviewed. Proved sites of involvement included the spleen (n = 2), bone marrow (n = 1), liver (n = 1), and peritoneal and pleural fluid (n = 1). CT findings included focal low-attenuation splenic lesions that became progressively calcified in rimlike or punctate fashion; punctate calcifications in the liver, renal cortices, and adrenal glands; calcification of lymph nodes; and pleural and peritoneal effusions with subsequent calcifications of the pleural and peritoneal surfaces. Although rare both before and since the onset of the AIDS epidemic, extrapulmonary P carinii infection in AIDS patients has been reported with increasing frequency in recent years, and more cases with radiologic manifestations should be expected
— id: 43693, year: 1990, vol: 174, page: 157, stat: Journal Article,

Visceral and nodal calcification in patients with AIDS-related Pneumocystis carinii infection
Radin DR; Baker EL; Klatt EC; Balthazar EJ; Jeffrey RB Jr; Megibow AJ; Ralls PW
1990 Jan;154(1):27-31, American journal of roentgenology
Clinical and radiologic findings in nine patients with AIDS and disseminated Pneumocystis carinii infection were analyzed retrospectively. The diagnosis was confirmed by autopsy (five patients) and by biopsy (two patients). All nine had a history of P. carinii pneumonia. CT showed parenchymal calcifications in the spleen (seven patients), liver (six patients), kidneys (six patients), abdominal lymph nodes (three patients), adrenal glands (two patients), and mediastinal lymph nodes (one patient). Multiple punctate calcifications in the liver, spleen, kidneys, and/or adrenal glands were visible on plain films in three patients. Sonography showed diffuse tiny echogenic foci without shadowing in the liver, spleen, and kidneys. In one patient, CT showed multiple hypodense lesions in the spleen. P. carinii infection should be included in the differential diagnosis when calcifications or focal lesions are detected at one or more extrapulmonary sites in an immunodeficient patient, even if there is no history or evidence of P. carinii pneumonia
— id: 43694, year: 1990, vol: 154, page: 27, stat: Journal Article,

CT diagnosis and staging of acute pancreatitis
Balthazar EJ
1989 Jan;27(1):19-37, Radiologic clinics of North America
Computed tomography is the single most important imaging modality in evaluating patients with acute pancreatitis. It has a high sensitivity and specificity in diagnosing 'moderate' and 'severe' pancreatitis, as well as in detecting serious complications which often are clinically unsuspected. In addition, computed tomography plays a valuable role as an early predictive indicator of disease severity. Patients with extrapancreatic phlegmonous collections and patients with pancreatic necrosis are considered to be at high risk to develop complications
— id: 10805, year: 1989, vol: 27, page: 19, stat: Journal Article,

CT of appendicitis
Balthazar EJ; Gordon RB
1989 Aug;10(4):326-340, Seminars in ultrasound CT & MR
— id: 10531, year: 1989, vol: 10, page: 326, stat: Journal Article,

Perirectal abscess in the Hermansky-Pudlak syndrome
Sherman A; Genuth L; Hazzi CG; Balthazar EJ; Schinella RA
1989 May;84(5):552-556, American journal of gastroenterology
The Hermansky-Pudlak syndrome (HPS) is a triad of tyrosine-positive albinism, platelet dysfunction, and the deposition of an abnormal ceroid-like pigment in the tissues. Complications of the syndrome, such as pulmonary fibrosis, renal failure, and cardiomyopathy, have been described. Granulomatous colitis has been documented in several families with the HPS. The bowel disease of the HPS is a unique type of inflammatory bowel disease with clinical features suggestive of idiopathic ulcerative colitis and pathologic features suggestive of Crohn's disease. Analogous to the presentation of Crohn's disease with perianal and perirectal involvement, we describe the occurrence of perianal disease and a perirectal abscess in a 29-yr-old woman with HPS and mild granulomatous colitis
— id: 10663, year: 1989, vol: 84, page: 552, stat: Journal Article,

Computed tomography of the abnormal appendix
Balthazar EJ; Megibow AJ; Gordon RB; Whelan CA; Hulnick D
1988 Jul-Aug;12(4):595-601, Journal of computer assisted tomography
This report describes the CT features of 29 abnormal appendices visualized during abdominal CT examinations. There were 22 cases of acute appendicitis, five mucoceles, and two mucinous adenocarcinomas of the appendix. The inflammed appendix appeared either as a fluid-filled slightly distended structure or as a collapsed small tubular structure. It was visualized on either cross or longitudinal sections and showed slight circumferential wall thickening. Periappendiceal inflammation was detected in 19 cases and intraluminal appendicoliths in six cases. Mucocele appeared as a larger fluid-filled round, oval, or tubular structure having a thin, sharp wall, low density contents, and no periappendiceal inflammation. Mucinous carcinoma appeared either as a single or as multiloculated, irregular shaped cystic lesion with solid elements. Infiltration of cecum and terminal ileum was seen in one case. In five cases the abnormal appendix was not recognized initially and was identified only after repeat 5 X 5 mm sections were obtained. During CT examination, demonstration of an abnormal appendix establishes the source of the abdominal pathology and helps greatly in the differential diagnosis
— id: 11036, year: 1988, vol: 12, page: 595, stat: Journal Article,

Carcinoma of the colon: detection and preoperative staging by CT
Balthazar EJ; Megibow AJ; Hulnick D; Naidich DP
1988 Feb;150(2):301-306, American journal of roentgenology
This report analyzes the detection rate and role of CT in the preoperative evaluation of 90 consecutive, proved cases of colon carcinoma. In this study, the overall detection rate was 84%; however, the rate varied from 68% in unprepared colons to 95% in clean colons that were adequately distended with air. Sensitivity of detection depends mainly on the size of the lesion and the quality of the examination. CT was less sensitive than barium enema in detection, but it had a similar specificity in differentiating neoplastic lesions from inflammatory lesions. On the basis of our criteria of staging, CT evaluation resulted in a sensitivity of 55% for local invasion, 73% for regional nodes, and 79% for liver metastases. Compared with Dukes classification, CT correctly staged 64% of all patients but showed significant variations in staging different groups with lower results in the Dukes A, B, and C patients. CT, however, showed a sensitivity of 81% and a positive predictive value of 100% in detecting Dukes D lesions. In general, although negative CT findings do not help in staging a colonic tumor, positive findings are highly indicative of neoplastic spread. We believe that this feature justifies the use of CT in the preoperative evaluation of colonic tumors
— id: 11199, year: 1988, vol: 150, page: 301, stat: Journal Article,

The current role of computerized tomography in inflammatory disease of the bowel
Lubat E; Balthazar EJ
1988 Feb;83(2):107-113, American journal of gastroenterology
CT has had a major and still evolving role in the diagnosis and management of inflammatory diseases of the bowel. The advantages of CT over conventional contrast examinations in these conditions include direct visualization of the bowel wall, detection of extramural disease, definition of the type and severity of such disease, visualization of all of the abdominal structures in one examination, and the noninvasive nature of the procedure. The current role of CT in diagnosis and management of these disorders varies. In diverticulitis, we believe CT should be used as the primary method of investigation, as well as for evaluation of complications. If surgical resection is not contemplated, the CT diagnosis should be confirmed by CE. In most cases of appendicitis, the diagnosis is still most accurately made clinically; radiographic evaluation should be reserved for cases with atypical clinical presentations. We advocate the use of CT as the first diagnostic procedure in these patients; if CT does not offer conclusive evidence of the diagnosis, contrast enema can be performed. In Crohn's disease, conventional barium studies remain the examinations of choice for diagnosis; CT should be used to evaluate possible complications and as a guide for proper management. Inflammatory colitides other than Crohn's disease primarily affect the mucosa, and are therefore best evaluated by barium enema; CT offers little additional information in these disorders. In all cases, conventional contrast studies and CT should be considered complimentary rather than exclusive procedures. In difficult cases, both examinations may be needed for complete evaluation
— id: 11195, year: 1988, vol: 83, page: 107, stat: Journal Article,

Prognostic value of CT in acute pancreatitis: is the early CT examination indicated?
Balthazar EJ
1987 Mar;162(3):876-878, Radiology
— id: 43892, year: 1987, vol: 162, page: 876, stat: Journal Article,

Computed tomography of intramural intestinal hemorrhage and bowel ischemia
Balthazar EJ; Hulnick D; Megibow AJ; Opulencia JF
1987 Jan-Feb;11(1):67-72, Journal of computer assisted tomography
The CT findings of eight patients with intramural intestinal hemorrhage are described and illustrated. Two patients had ischemic bowel disease: in the other six cases pertinent clinical histories led to an accurate diagnosis. Computed tomography demonstrated similar findings consisting of circumferential and symmetrical wall thickening homogeneous in density, a slightly narrowed intestinal lumen, and sharp outer contour. The disease had a segmental distribution affecting different parts of the intestinal tract. In six patients edematous and congestive mesenteric changes were seen and in two patients intraperitoneal blood was detected. An adequate history and careful clinical evaluation are crucial in differentiating the more benign forms of intramural hemorrhage from bowel ischemia
— id: 26431, year: 1987, vol: 11, page: 67, stat: Journal Article,

Cecal diverticulitis: evaluation with CT
Balthazar EJ; Megibow AJ; Gordon RB; Hulnick D
1987 Jan;162(1 Pt 1):79-81, Radiology
The findings of computed tomographic (CT) examinations in seven patients with cecal diverticulitis are described and correlated with those of barium studies. The CT findings were linear and streaky densities in the pericecal fat compatible with pericecal inflammation (seven cases), intramural abscess (one case), thickening of the cecal wall (two cases), and cecal diverticulum (one case). Barium studies, available in four patients, led to a correct diagnoses of diverticulitis in two cases. CT scanning is a sensitive means by which to detect cecal diverticulitis. The radiographic appearance of the disease, however, mimics that of appendicitis, unless more specific findings such as cecal diverticula or intramural abscess with adjacent inflammation is detected. CT and barium study are complementary methods of examination that improve our ability to diagnose cecal diverticulitis and its complications
— id: 43699, year: 1987, vol: 162, page: 79, stat: Journal Article,

Cytomegalovirus esophagitis in AIDS: radiographic features in 16 patients
Balthazar EJ; Megibow AJ; Hulnick D; Cho KC; Beranbaum E
1987 Nov;149(5):919-923, American journal of roentgenology
Cytomegalovirus is one of the more common opportunistic organisms implicated in the development of esophagitis in patients with AIDS. A review of the radiographic features of 16 proved cases of cytomegalovirus esophagitis showed a spectrum of abnormalities related to the severity of the inflammatory process. Seven patients had a mild form of esophagitis with segmental involvement characterized by granular mucosa, superficial erosions, and poorly defined, shallow ulcerations. Nine patients had more severe esophagitis with solitary or multiple deep ulcers and a background of normal mucosa. The deep ulcerations were oval in shape and varied in size. Some projected intraluminally and had a thin rim of radiolucency at the base. Short-term follow-up examinations showed progression of the disease in four patients, no change in one patient, and regression without specific therapy in one patient. Although these radiographic features are highly suggestive of cytomegalovirus esophagitis, the diagnosis requires histologic confirmation
— id: 11340, year: 1987, vol: 149, page: 919, stat: Journal Article,

CT evaluation of esophageal varices
Balthazar EJ; Naidich DP; Megibow AJ; Lefleur RS
1987 Jan;148(1):131-135, American journal of roentgenology
CT findings in 20 consecutive patients with proven esophageal varices are reviewed and analyzed. In 85% of patients, abnormalities were seen involving the esophageal wall and/or periesophageal region. In 65%, findings specific to varices were present: thickening of esophageal wall, a scalloped contour, and intraluminal protrusions enhancing after a contrast bolus injection. These findings were seen alone or in association with periesophageal varices, which were seen in 45% of patients; evidence of portal hypertension with varices in the lesser omentum was present in 95%. CT has a sensitivity similar to barium esophagram but evaluates better the presence and extent of periesophageal varices and portal hypertension. Normal CT does not rule out esophageal varices because small varices may escape detection, particularly in scans done without a contrast bolus injection
— id: 23441, year: 1987, vol: 148, page: 131, stat: Journal Article,

CECAL DIVERTICULITIS - EVALUATION WITH CT - REPLY
Balthazar, EJ
1987 Jun;163(3):832-832, Radiology
— id: 31181, year: 1987, vol: 163, page: 832, stat: Journal Article,

Ileocecal tuberculosis in a patient with the acquired immune deficiency syndrome
Dickerman SA; Sherman A; Balthazar EJ; Hazzi C
1987 Nov;83(5):1010-1011, American journal of medicine
— id: 43891, year: 1987, vol: 83, page: 1010, stat: Journal Article,

Gastric duplication cyst: GI series and CT correlation
Hulnick DH; Balthazar EJ
1987 ;12(2):106-108, Gastrointestinal radiology
The radiographic and computed tomographic findings of a communicating gastric duplication first diagnosed in a 55-year-old man are presented and the pertinent literature is reviewed
— id: 43893, year: 1987, vol: 12, page: 106, stat: Journal Article,

Diverticulitis: evaluation by CT and contrast enema
Hulnick DH; Megibow AJ; Balthazar EJ
1987 Sep;149(3):644-646, American journal of roentgenology
— id: 43697, year: 1987, vol: 149, page: 644, stat: Journal Article,

Perforated colorectal neoplasms: correlation of clinical, contrast enema, and CT examinations
Hulnick DH; Megibow AJ; Balthazar EJ; Gordon RB; Surapenini R; Bosniak MA
1987 Sep;164(3):611-615, Radiology
Results of clinical, contrast enema (CE), and computed tomographic (CT) examinations in 39 patients with perforated colorectal neoplasms were retrospectively reviewed. Twenty patients were toxemic at initial presentation, but in only four patients was the diagnosis of perforated colorectal neoplasm initially suspected clinically. CE study was performed in 22 patients and enabled the diagnosis of perforated neoplasm in 11 cases, neoplasm alone in eight, and neither neoplasm nor perforation in three. CT was performed in 38 patients and enabled the diagnosis of perforated neoplasm in 36; pericolic phlegmon but no mass lesion was evident in two. In 16 patients, CT also demonstrated metastatic disease. Because of its reliability in establishing the diagnosis and staging the extent of the inflammatory and neoplastic disease, CT is indicated in cases of suspected or proved perforated colorectal neoplasm and in cases in which CE study findings are indeterminate or suggestive of perforated neoplasm
— id: 43696, year: 1987, vol: 164, page: 611, stat: Journal Article,

Radiology of nonneoplastic gastrointestinal disorders in acquired immune deficiency syndrome
Megibow AJ; Balthazar EJ; Hulnick DH
1987 Jan;22(1):31-41, Seminars in roentgenology
— id: 43698, year: 1987, vol: 22, page: 31, stat: Journal Article,

CT of appendicitis
Balthazar EJ; Megibow AJ; Hulnick D; Gordon RB; Naidich DP; Beranbaum ER
1986 Oct;147(4):705-710, American journal of roentgenology
The CT findings of 38 consecutive patients with acute appendicitis are analyzed, described, and illustrated. CT showed intraabdominal disease in 92% of patients and made a specific diagnosis of appendicitis in 79% of cases. The most common CT findings were pericecal inflammation (68%), abscess (55%), calcified appendicolith (23%), and an abnormal appendix (18%). CT had a sensitivity similar to that of contrast enema examinations, but it correlated much better with the surgical findings in detecting the precise nature, extent, and location of the disease process. Normal CT does not exclude appendicitis, since mild forms without periappendiceal disease may escape detection
— id: 43700, year: 1986, vol: 147, page: 705, stat: Journal Article,

The significance of small bowel intussusception in acquired immune deficiency syndrome
Balthazar EJ; Reich CB; Pachter HL
1986 Nov;81(11):1073-1075, American journal of gastroenterology
The etiology, radiographic diagnosis, and surgical management of small bowel intussusception in adults have been well documented in the literature. It has been shown that unlike the intussusceptions seen in infants, the adult variety is in most cases associated with a focal pathological process and that surgical reductions and often segmental resections are indicated. We have recently examined a patient with acquired immune deficiency syndrome presenting with small bowel intussusception who at surgery showed no evidence of a leading pathological cause. The purpose herein is to underline the potential development of transitory intussusceptions in patients with acquired immune deficiency syndrome, based on the common association of diffuse enteritis. In these patients, a correct interpretation of the radiographic findings may prevent unnecessary surgical explorations
— id: 43894, year: 1986, vol: 81, page: 1073, stat: Journal Article,

GASTROINTESTINAL PLASMACYTOMAS
FARMAN, J; BALTHAZAR, E; JAVORS, BR; BASHIST, B
1986 JUL ;11(3):292-293, Gastrointestinal radiology
— id: 41393, year: 1986, vol: 11, page: 292, stat: Journal Article,

DIVERTICULITIS EVALUATED BY COMPUTED-TOMOGRAPHY
HULNICK, DH; MEGIBOW, AJ; BALTHAZAR, EJ; HOROWITZ, L
1986 MAY ;90(5):1469-1469, Gastroenterology
— id: 41455, year: 1986, vol: 90, page: 1469, stat: Journal Article,

The Hermansky-Pudlak syndrome: radiographic features
Leitman BS; Balthazar EJ; Garay SM; Naidich DP; McCauley DI
1986 Mar;37(1):42-45, Canadian Association of Radiologists journal
We present the radiologic features of four patients proven to have Hermansky-Pudlak syndrome. All four patients had evidence of pulmonary involvement characterized by a progressive, diffuse, bilateral interstitial fibrosis. Extensive bullous changes were seen in one patient. Two patients with evidence of diffuse colitis exhibited an asymmetrical pattern of focal, superficial, and deep ulcerations similar to that of Crohn's disease. The association of these radiographic abnormalities with albinism, ocular abnormalities, bleeding diathesis, and Puerto Rican ancestry establishes the diagnosis
— id: 34078, year: 1986, vol: 37, page: 42, stat: Journal Article,

THE HERMANSKY-PUDLAK SYNDROME - RADIOGRAPHIC FEATURES
LEITMAN, BS; BALTHAZAR, EJ; GARAY, SM; NAIDICH, DP; MCCAULEY, DI
1986 MAR ;37(1):42-45, Journal of the Canadian Association of Radiologists
— id: 41578, year: 1986, vol: 37, page: 42, stat: Journal Article,

CT OF GASTRIC-CARCINOMA - A REVIEW OF 60 PATIENTS
MEGIBOW, AJ; HULNICK, DH; BALTHAZAR, EJ
1986 JUL ;11(3):294-294, Gastrointestinal radiology
— id: 41394, year: 1986, vol: 11, page: 294, stat: Journal Article,

Computed tomography of the gastrointestinal tract
Megibow, Alec J.; Balthazar, Emil J
St. Louis : Mosby, 1986,
— id: 418, year: 1986, vol: , page: , stat: ,

CT diagnosis of closed loop obstruction
Balthazar EJ; Bauman JS; Megibow AJ
1985 Sep-Oct;9(5):953-955, Journal of computer assisted tomography
A case of closed loop obstruction presenting with unremarkable plain abdominal films and diagnosed by CT is reported. The presence of (a) fluid filled distended small bowel loops; (b) abrupt transition with collapsed distal intestinal loops; and (c) grossly distended fluid filled 'U' shaped loop are diagnostic of this entity. Prompt CT recognition, before signs of intestinal gangrene develop, will lead to immediate surgical decompression and a significant decrease in the morbidity and mortality of this potential abdominal catastrophe
— id: 43703, year: 1985, vol: 9, page: 953, stat: Journal Article,

CT of splenic and perisplenic abnormalities in septic patients
Balthazar EJ; Hilton S; Naidich D; Megibow A; Levine R
1985 Jan;144(1):53-56, American journal of roentgenology
Splenic and perisplenic pathology, demonstrated by CT examination in 14 septic patients, was correlated with the clinical course and with surgical and pathologic findings available. Twelve patients were intravenous drug addicts and two patients developed bacteremia associated with bacterial endocarditis. The CT findings were divided into three groups: (1) Single wedge-shaped peripherally located defects were seen in five patients; there was good response to medical therapy without other complications. (2) Larger and/or multiple, rounded or oval lesions were present in five patients; two of these patients had splenic abscesses proven on subsequent splenectomy. (3) Multiple splenic lesions and fissures associated with perisplenic and subphrenic fluid collections were seen in four patients; infected splenic infarcts, splenic fractures, and infected perisplenic hemorrhagic fluid collections were found in this group of patients. The CT examination in septic patients can reliably demonstrate splenic and perisplenic pathology, and its appearance contributes greatly to the overall clinical assessment and surgical approach
— id: 43710, year: 1985, vol: 144, page: 53, stat: Journal Article,

CT evaluation of pancreatic injury following splenectomy
Balthazar EJ; Megibow A; Rothberg M; Lefleur RS
1985 ;10(2):139-144, Gastrointestinal radiology
A fluid collection in the left subphrenic space immediately after splenectomy is often associated with pancreatic injury. The configuration, location, and vascular supply of the tail of the pancreas explain this postoperative complication. Depending on the degree of injury, the CT findings may show swelling of the tail of the pancreas, ill-defined fluid collections, or a well-encapsulated pancreatic pseudocyst. The diagnosis is confirmed by percutaneous aspiration with amylase determinations and the demonstration of a pancreatic fistula. Failure to diagnose this complication promptly may lead to a protracted postoperative clinical course and the development of a subphrenic abscess or a pancreatic pseudocyst
— id: 23442, year: 1985, vol: 10, page: 139, stat: Journal Article,

Cytomegalovirus colitis in AIDS: radiographic findings in 11 patients
Balthazar EJ; Megibow AJ; Fazzini E; Opulencia JF; Engel I
1985 Jun;155(3):585-589, Radiology
Radiographic findings in 11 proved cases of cytomegalovirus (CMV) colitis were reviewed and correlated with colonoscopic and pathologic findings. Patients were chronically ill homosexual men with multiple systemic opportunistic infections. Endoscopies showed focal or diffuse inflammation, hemorrhagic plaques, and superficial colonic ulcers. Biopsies revealed inflammatory cells associated with cytoplasmic and intranuclear inclusion bodies. Barium enema examinations showed mucosal granularity, superficial erosions, thickened folds, and spasticity. Disease was either diffuse (four patients) or segmental (two patients), or it involved the cecum exclusively (three patients). Two patients had normal barium enema studies. Computed tomography scans in two patients demonstrated marked colonic wall thickening and mucosal ulcerations. In the homosexual population with acquired immunodeficiency syndrome, CMV colitis should be part of the differential diagnosis of diffuse colitis, segmental colitis, or typhlitis
— id: 26432, year: 1985, vol: 155, page: 585, stat: Journal Article,

Cytomegalovirus esophagitis and gastritis in AIDS
Balthazar EJ; Megibow AJ; Hulnick DH
1985 Jun;144(6):1201-1204, American journal of roentgenology
The radiographic features of cytomegalovirus involvement of the upper gastrointestinal tract in four homosexual men with acquired immunodeficiency syndrome (AIDS) are described. Esophageal involvement (three cases) was demonstrated as a localized ulceration or as a more diffuse esophagitis affecting predominantly the distal esophagus. Gastric involvement (two cases) presented as large nodular rugal folds in the fundus or as a circumferentially narrowed antrum deformed by numerous large nodular contour defects. Endoscopy revealed mucosal erosions, serpiginous ulcers, and inflammatory exudate; biopsies documented the presence of typical inclusion bodies in the epithelial and endothelial cells. Although the radiographic findings are nonspecific, the diagnosis of cytomegalovirus esophagitis and gastritis should be suspected when similar abnormalities are present in immunocompromised patients, particularly homosexual men with AIDS
— id: 43706, year: 1985, vol: 144, page: 1201, stat: Journal Article,

Acute pancreatitis: prognostic value of CT
Balthazar EJ; Ranson JH; Naidich DP; Megibow AJ; Caccavale R; Cooper MM
1985 Sep;156(3):767-772, Radiology
In 83 patients with acute pancreatitis, the initial computed tomographic (CT) examinations were classified by degree of disease severity (grades A-E) and were correlated with the clinical follow-up, objective prognostic signs, and complications and death. The length of hospitalization correlated well with the severity of the initial CT findings. Abscesses occurred in 21.6% of the entire group, compared with 60.0% of grade E patients. Pleural effusions were also more common in grade E patients. Grades A and B patients did not have abscesses, and none died, regardless of the number of prognostic signs. Abscesses were seen in 80.0% of patients with six to eight prognostic signs, compared with 12.5% of those with zero to two. The use of prognostic signs with initial CT findings results in improved prognostic accuracy. Early CT examination of patients with acute pancreatitis is a useful prognostic indicator of morbidity and mortality
— id: 43704, year: 1985, vol: 156, page: 767, stat: Journal Article,

COMPUTED-TOMOGRAPHY FOLLOWING BILLROTH-II PARTIAL GASTRECTOMY
Berliner, L; Megibow, AJ; Redmond, P; Balthazar, E
1985 ;10(3):305-305, Gastrointestinal radiology
— id: 30887, year: 1985, vol: 10, page: 305, stat: Journal Article,

Cytomegalovirus esophagogastritis in a patient with acquired immunodeficiency syndrome
Freedman PG; Weiner BC; Balthazar EJ
1985 Jun;80(6):434-437, American journal of gastroenterology
Symptomatic cytomegalovirus involvement of the gastrointestinal tract has become increasingly recognized in patients with acquired immunodeficiency syndrome. This may take varying forms, often mimicking more well known entities. This is a report of a male intravenous drug abuser with documented acquired immunodeficiency syndrome, who developed dysphagia and evidence of distal esophagitis. Although this was initially thought to be related to reflux peptic disease, he subsequently was documented to have cytomegalovirus esophagitis and gastritis. His course was further complicated by small bowel perforation with cytomegalovirus found here as well. Cytomegalovirus infection, in general, and its increasingly recognized role in the morbidity of patients with acquired immunodeficiency syndrome, is discussed
— id: 43898, year: 1985, vol: 80, page: 434, stat: Journal Article,

A role for radiotherapy in the treatment of solid and papillary neoplasms of the pancreas
Fried, P; Cooper, J; Balthazar, E; Fazzini, E; Newall, J
1985 Dec 15;56(12):2783-2785, Cancer
Solid and papillary neoplasms of the pancreas are rare tumors that usually occur in young women as enlarging abdominal masses. These lesions almost never metastasize but may be locally destructive. Although the usual treatment is surgery, the authors herein report a case that was treated solely by radiotherapy. They conclude that solid and papillary neoplasms of the pancreas are radiosensitive and can be successfully treated by radiation therapy
— id: 125862, year: 1985, vol: 56, page: 2783, stat: Journal Article,

CT diagnosis of cholecystoduodenal fistula
Harkavy LA; Balthazar EJ; Naidich DP
1985 Jul;80(7):569-571, American journal of gastroenterology
— id: 43897, year: 1985, vol: 80, page: 569, stat: Journal Article,

Abdominal tuberculosis: CT evaluation
Hulnick DH; Megibow AJ; Naidich DP; Hilton S; Cho KC; Balthazar EJ
1985 Oct;157(1):199-204, Radiology
The computed tomography (CT) scans of 27 patients with abdominal tuberculosis were reviewed retrospectively to determine the range of abdominal involvement. Most patients had been at increased risk because of intravenous drug abuse, alcoholism, acquired immunodeficiency syndrome (AIDS), cirrhosis, or steroid therapy. The etiologic agent was Mycobacterium tuberculosis in 23 patients and M. avium-intracellulare in four patients with AIDS. In five patients, tuberculosis was limited to the abdomen. CT findings included adenopathy, splenomegaly, hepatomegaly, ascites, bowel involvement, pleural effusion, intrasplenic masses, and intrahepatic masses. Characteristic features were a tendency for adenopathy to prominently involve peripancreatic and mesenteric compartments, low-density centers within enlarged nodes, complex nature of the ascites, and adenopathy adjacent to sites of gastrointestinal tract involvement. Recognition of these manifestations and maintenance of an index of suspicion, especially in patients at risk, should help optimize the correct diagnosis and management of intraabdominal tuberculosis
— id: 43702, year: 1985, vol: 157, page: 199, stat: Journal Article,

COMPUTED-TOMOGRAPHY IN THE EVALUATION OF DIVERTICULITIS - REPLY
Hulnick, DH; Megibow, AJ; Balthazar, EJ; Naidich, DP; Bosniak, MA
1985 ;154(3):836-836, Radiology
— id: 30990, year: 1985, vol: 154, page: 836, stat: Journal Article,

CT evaluation of gastrointestinal leiomyomas and leiomyosarcomas
Megibow AJ; Balthazar EJ; Hulnick DH; Naidich DP; Bosniak MA
1985 Apr;144(4):727-731, American journal of roentgenology
Computed tomographic (CT) features in 29 patients with gastrointestinal leiomyomas and leiomyosarcomas were analyzed and compared. Features evaluated included size, shape, homogeneity, response to intravenous contrast material, and presence of calcification. The sarcomas were larger (average, 12 cm) than the myomas (average, 4.8 cm), had an irregular shape, and had a nonhomogeneous appearance both before and after contrast enhancement. Gross features depicted on CT are compared with gross pathologic criteria. Analysis of the CT appearance suggested malignancy in two cases in which microscopic examination was interpreted as benign
— id: 43707, year: 1985, vol: 144, page: 727, stat: Journal Article,

Ovarian metastases: computed tomographic appearances
Megibow AJ; Hulnick DH; Bosniak MA; Balthazar EJ
1985 Jul;156(1):161-164, Radiology
Computed tomographic scans of 34 patients with ovarian metastases were reviewed to assess the radiographic appearances and to correlate these with the primary neoplasms. Primary neoplasms were located in the colon (20 patients), breast (six), stomach (five), small bowel (one), bladder (one), and Wilms tumor of the kidney (one). The radiographic appearance of the metastatic lesions could be described as predominantly cystic (14 lesions), mixed (12 lesions), or solid (seven lesions). There was one false-negative examination which showed no ovarian enlargement, although neoplastic deposits were found on the ovary at laparotomy. The cystic and mixed lesions tended to be larger in overall diameter than the solid. The metastases from gastric carcinoma appeared solid in four of five cases. The metastases from the other neoplasms had variable appearances simulating primary ovarian carcinoma
— id: 43705, year: 1985, vol: 156, page: 161, stat: Journal Article,

Computed tomography and the prediction of pancreatic abscess in acute pancreatitis
Ranson, J H; Balthazar, E; Caccavale, R; Cooper, M
1985 May;201(5):656-665, Annals of surgery
Pancreatic abscess has become the most common cause of death from acute pancreatitis. Since computed tomography (CT) permits noninvasive imaging of the peripancreatic anatomy, the relationship of early CT findings to late pancreatic sepsis has been evaluated in 83 patients with acute pancreatitis. Pancreatic abscesses developed in 18 patients and were responsible for five of the six deaths in this study. Initial CT findings were graded: A = normal, in 12 patients; B = pancreatic enlargement alone, in 19; C = inflammation confined to pancreas and peripancreatic fat, in 17; D = one peripancreatic fluid collection, in 12; and E = two or more fluid collections, in 23. The incidence of pancreatic abscess in grades A and B was 0%; in grade C, 11.8%; in grade D, 16.7; and in grade E, 60.9%. The severity of pancreatitis was also graded by previously reported prognostic signs as 'mild' (0-2 signs) in 56 patients, 'moderate' (3-5 signs) in 22, and 'severe' (greater than or equal to 6 signs) in five patients. The incidence of abscesses in mild disease was 12.5%; in moderate, 31.8%; and in severe, 80%. Fluid collections on CT resolved spontaneously in 19 of 35 (54.3%) patients. Abscess developed in two patients with no fluid collections on initial CT study. No abscess occurred in 31 patients with CT grades A or B, and in one of 22 patients (4.5%) with CT grade C or D and less than three positive prognostic signs. Among 30 patients with CT grade E or CT grade C or D and three or more positive prognostic signs, 17 (56.7%) developed abscesses. All deaths were in patients with five or more positive prognostic signs. Early imaging of the pancreas by CT identifies a group of patients with increased risk of pancreatic abscess. Identification of this group is improved further by use of early objective prognostic signs
— id: 92874, year: 1985, vol: 201, page: 656, stat: Journal Article,

Jejunal perforation by a toothpick: CT demonstration
Strauss JE; Balthazar EJ; Naidich DP
1985 Jul-Aug;9(4):812-814, Journal of computer assisted tomography
Ingested foreign bodies are often seen in clinical practice, but their radiographic demonstration is unusual unless they have a metallic or bony density. This report describes and illustrates a case of small bowel perforation secondary to an ingested wooden toothpick and emphasizes the role of CT in evaluating similar cases
— id: 43896, year: 1985, vol: 9, page: 812, stat: Journal Article,

Abdominal lymphadenopathy in intravenous drug addicts: sonographic features and clinical significance
Subramanyam BR; Balthazar EJ; Horii SC; Hilton S
1985 May;144(5):917-920, American journal of roentgenology
The sonographic features of abdominal lymphadenopathy in 35 patients with history of intravenous drug addiction were analyzed to assess their clinical significance. Of the 28 proven cases, 15 were due to reactive hyperplasia, 10 to infections, and three to neoplasms. Sonography was helpful in assessing the pathologic nature of these nodes. Most nodes attributable to reactive hyperplasia were small (less than or equal to 1.5 cm diam) and showed a characteristic distribution in the porta hepatis, celiac axis, and peripancreatic regions. Hypoechoic nodes were always pathologic, due either to tuberculosis or to neoplasm. Nodes larger than 1.5 cm in diameter and primarily involving the lower retroperitoneum, splenic hilum, and mesentery are highly suspicious for pathologic nodes, and appropriate biopsies are indicated for diagnosis
— id: 43899, year: 1985, vol: 144, page: 917, stat: Journal Article,

Presacral myelolipoma: CT findings
Sutker B; Balthazar EJ; Fazzini E
1985 Nov-Dec;9(6):1128-1130, Journal of computer assisted tomography
The CT findings of a proven presacral myelolipoma are described, illustrated, and discussed. This lesion presents as an encapsulated mixed but predominantly fatty soft tissue mass located in the extraperitoneal retrorectal space. It occurs in asymptomatic individuals usually between the 5th to 8th decades, with a slight female predominance and without significant hematologic disturbances. This entity should be included in the differential diagnosis of a fat-containing presacral lesion. Familiarization with its typical CT appearance may permit a percutaneous needle biopsy diagnosis, avoiding unnecessary surgery
— id: 43895, year: 1985, vol: 9, page: 1128, stat: Journal Article,

Computed tomographic recognition of gastric varices
Balthazar EJ; Megibow A; Naidich D; LeFleur RS
1984 Jun;142(6):1121-1125, American journal of roentgenology
The computed tomographic (CT) findings in 13 consecutive patients with proven gastric varices were analyzed and correlated with the radiographic, angiographic, and gastroscopic evaluations. In 11 patients, CT clearly identified large (five) or smaller (six) varices located mainly along the posteromedial wall of the gastric fundus and proximal body of the stomach. Well defined rounded or tubular densities that enhanced during intravenous administration of contrast material and could not be distinguished from the gastric wall were identified. Dense, enhancing, round or tubular, intraluminal filling defects were seen in the cases where the stomach was distended with water. In two patients, the CT diagnosis of gastric varices could not be confidently made. All patients had associated intraabdominal collateral circulation, situated medial to the stomach within the lesser omentum, along the distribution of the coronary venous system. In seven patients, the CT examination correctly diagnosed the pathogenesis of gastric varices by identifying hepatic cirrhosis, calcific pancreatitis, and carcinoma of the pancreas
— id: 23445, year: 1984, vol: 142, page: 1121, stat: Journal Article,

Anorectal giant condyloma acuminatum (Buschke-Loewenstein tumor): CT and radiographic manifestations
Balthazar EJ; Streiter M; Megibow AJ
1984 Mar;150(3):651-653, Radiology
Giant condyloma acuminatum (Buschke-Loewenstein tumor) is an unusual variety of venereal wart characterized by a large size, cauliflower-like appearance, and locally invasive nature. CT examination of two patients with anorectal giant condylomata revealed the papillomatous and invasive nature of the lesion and the extent of tumor; there was infiltration of the subcutaneous tissue, perirectal fascial planes, and luminal narrowing with marked thickening of the rectal wall. The pathologic specimens showed benign histologic findings in one case and a mixed pattern with areas of malignant degeneration in the other. CT accurately demonstrated the exact location and extent of the lesions. The presence of malignant degeneration in this inherently invasive lesion can be established only on histologic examination
— id: 43717, year: 1984, vol: 150, page: 651, stat: Journal Article,

Solid and papillary epithelial neoplasm of the pancreas. Radiographic, CT, sonographic, and angiographic features
Balthazar EJ; Subramanyam BR; Lefleur RS; Barone CM
1984 Jan;150(1):39-40, Radiology
Solid and papillary epithelial neoplasm of the pancreas is a nonfunctioning tumor seen a slowly enlarging upper abdominal mass in young women. It is usually large, well encapsulated, and undergoing necrotic degeneration. On ultrasound, it is sharply defined, nonhomogeneous, and lacking central enhancement. On angiography, it can be avascular or hypovascular depending on the degree of necrosis. Calcification has not been reported, and metastatic deposits are rare. Excision leads to an excellent prognosis
— id: 23447, year: 1984, vol: 150, page: 39, stat: Journal Article,

Spigelian hernia: CT and ultrasonography diagnosis
Balthazar EJ; Subramanyam BR; Megibow A
1984 ;9(1):81-84, Gastrointestinal radiology
The diagnostic potential of CT and sonography in detecting clinically unrecognized cases of spigelian hernia is illustrated and discussed. These imaging modalities can promptly and reliably diagnose spigelian hernia based on the following findings: (1) peritoneal and muscular defect along the spigelian line in the lower abdomen; (2) intraparietal location of the hernial sac; and (3) hernial sac containing omentum and/or mesentery and loops of bowel. Two recently diagnosed cases are presented together with a short review of the literature
— id: 43718, year: 1984, vol: 9, page: 81, stat: Journal Article,

Crohn's disease of the esophagus: case report and review of the literature
Freedman PG; Dieterich DT; Balthazar EJ
1984 Nov;79(11):835-838, American journal of gastroenterology
Crohn's disease of the esophagus is a rare entity, especially when the esophageal manifestations are the first symptoms. We describe a 28-year-old man who presented with dysphagia, fevers, and weight loss and was eventually found to have Crohn's disease of the terminal ileum, cecum, and esophagus. A review of the English language literature reveals approximately 30 reported cases of Crohn's disease of the esophagus, with or without other gastrointestinal involvement
— id: 14728, year: 1984, vol: 79, page: 835, stat: Journal Article,

Multifocal granular cell tumors of the gastrointestinal tract
Fried KS; Arden JL; Gouge TH; Balthazar EJ
1984 Oct;79(10):751-755, American journal of gastroenterology
Granular cell tumors infrequently appear in the gastrointestinal tract. Lesions have been reported in all segments from the esophagus to the rectum, but no previous reports have identified simultaneous lesions in various segments. We describe a patient with granular cell tumors of the esophagus, stomach, appendix, and cecum. Our case emphasizes the need to evaluate the entire gastrointestinal tract when a single lesion is identified. The radiographic approach and pathological characteristics are discussed. Therapeutic alternatives are presented
— id: 43901, year: 1984, vol: 79, page: 751, stat: Journal Article,

Computed tomography in the evaluation of diverticulitis
Hulnick DH; Megibow AJ; Balthazar EJ; Naidich DP; Bosniak MA
1984 Aug;152(2):491-495, Radiology
Computed tomography (CT) was performed in 43 cases of colonic diverticulitis and compared with the contrast-enema examination (CE) in 37 patients. Findings on CT included inflammation of the pericolic fat in 98% of cases, diverticula in 84%, thickening of the colon wall in 70%, a pericolic abscess in 35%, peritonitis in 16%, a fistula in 14%, colon obstruction in 12%, and intramural sinus tracts in 9%. Secondary findings included a distant abscess in 12% and ureteral obstruction in 7%. In addition to detecting ureteral and bladder involvement and distant abscess formation, CT was preferable for demonstrating the extent of pericolic inflammation, which was underestimated with CE in 41% of patients. Differential diagnosis of the CT findings is discussed. The authors indicate that CT should be the initial procedure in patients with suspected diverticulitis, particularly when CE is contraindicated
— id: 43713, year: 1984, vol: 152, page: 491, stat: Journal Article,

Lumbar artery pseudoaneurysm: CT demonstration
Hulnick DH; Naidich DP; Balthazar EJ; Megibow AJ; Bosniak MA
1984 Jun;8(3):570-572, Journal of computer assisted tomography
A psoas mass in a patient with a history of penetrating trauma to the area was demonstrated by computed tomography (CT) to represent a lumbar artery pseudoaneurysm surrounded by hematoma. This report emphasizes the importance of recognizing the anatomic position of the lumbar arteries on CT images and considering the possibility of pseudoaneurysm in the differential diagnosis of post-traumatic psoas masses
— id: 43715, year: 1984, vol: 8, page: 570, stat: Journal Article,

Pseudomembranous colitis: diagnosis by computed tomography
Megibow AJ; Streiter ML; Balthazar EJ; Bosniak MA
1984 Apr;8(2):281-283, Journal of computer assisted tomography
Although the diagnosis of pseudomembranous colitis is generally straightforward in the appropriate clinical setting, patients may manifest clinical symptoms more suggestive of abdominal infection than of intestinal disease. Because these patients may have computed tomography (CT) as their first examination, it becomes important to recognize colonic changes that may reflect the presence of pseudomembranous colitis. We present two cases of this entity diagnosed by CT findings
— id: 43716, year: 1984, vol: 8, page: 281, stat: Journal Article,

Air insufflation of the colon as an adjunct to computed tomography of the pelvis
Megibow AJ; Zerhouni EA; Hulnick DH; Beranbaum ER; Balthazar EJ
1984 Aug;8(4):797-800, Journal of computer assisted tomography
Air insufflation of the colon as an adjunct to pelvic CT examinations was performed in 49 patients for evaluation of a known or suspected pelvic mass or in follow-up of treated pelvic tumors. This safe, simple method of colonic visualization clearly outlines the rectosigmoid colon and permits a reliable assessment of the mucosa, wall thickness, and extrinsic abnormalities, thereby improving diagnostic accuracy in staging pelvic malignancy and evaluating pelvic pathology
— id: 43714, year: 1984, vol: 8, page: 797, stat: Journal Article,

Hepatocellular carcinoma with venous invasion. Sonographic-angiographic correlation
Subramanyam BR; Balthazar EJ; Hilton S; Lefleur RS; Horii SC; Raghavendra BN
1984 Mar;150(3):793-796, Radiology
Ultrasound was correlated with angiography for assessment of tumor extension to the intrahepatic inferior vena cava, hepatic veins, and portal vein branches in 15 cases of hepatocellular carcinoma (HCC) and 85 cases of hepatic metastases. Sonography revealed intraluminal tumor thrombus in 5 cases of HCC (33%), which were confirmed by angiography (sensitivity and specificity = 100%), and in 1 case of hepatic metastases (1%). Sonography was superior in depicting veins obscured or nonopacified on angiography, which in turn demonstrated arteriovenous shunting not appreciated on sonography. Used as the initial procedure for evaluation of venous extension of HCC, ultrasound can suggest the histology (though this must be confirmed by biopsy) and determine the feasibility of resection
— id: 23446, year: 1984, vol: 150, page: 793, stat: Journal Article,

Sonography of the accessory spleen
Subramanyam BR; Balthazar EJ; Horii SC
1984 Jul;143(1):47-49, American journal of roentgenology
The sonographic features of 20 accessory spleens in 19 patients are presented. They are round or oval solid structures with their echogenicity similar to that of the main spleen. They are surrounded by high-amplitude interfaces that separate them from adjacent parenchymal organs. Sonographic demonstration of blood supply to the accessory spleens from the splenic artery or vein was diagnostic and was possible in 90% of the cases. Sonography could be used preoperatively in detecting and locating accessory spleens in patients who may need splenectomy for hematologic disease
— id: 43902, year: 1984, vol: 143, page: 47, stat: Journal Article,

Portal venous thrombosis: correlative analysis of sonography, CT and angiography
Subramanyam BR; Balthazar EJ; Lefleur RS; Horii SC; Hulnick DH
1984 Oct;79(10):773-776, American journal of gastroenterology
In 17 patients with portal venous thrombosis; nine due to venous invasion by liver tumors, and eight due to benign causes, sonograms and CT scans were reviewed, and the results were correlated with angiography. Sonography detected portal venous thrombosis in 94% and CT in 76%. Sonography was better than CT in the demonstration of the extent of thrombosis. By the detection of solid masses in the liver, and contiguous thrombosis of the segmental portal veins, both sonography and CT were accurate in the differentiation of venous invasion by tumor from benign thrombosis. Angiography was 91% accurate and was unique in the demonstration of arterioportal shunting and detailed vascular anatomy of the portal venous system
— id: 43900, year: 1984, vol: 79, page: 773, stat: Journal Article,

Ultrasonic features of cholangiocarcinoma
Subramanyam BR; Raghavendra BN; Balthazar EJ; Horii SC; LeFleur RS; Rosen RJ
1984 Sep;3(9):405-408, Journal of ultrasound in medicine
Sonographic features in 12 cases of proven cholangiocarcinoma were analyzed and correlated with findings on direct cholangiography. Proximal bile duct dilation was present in all cases of cholangiocarcinoma of the intrahepatic ducts except one. A neoplastic bile duct segment was detected in nine of the 12 cases. The neoplasms were seen as narrowed, normal-sized, or enlarged ducts, and contained intraluminal soft-tissue echoes or echogenic bands across the lumens. The sonographic accuracy was greater for lesions involving the bifurcation and the common hepatic duct than for common bile duct lesions. Cholangiography was superior to sonography in determining the length of the involved segment, whereas sonography was superior in detecting hepatic invasion and lymphadenopathy
— id: 23444, year: 1984, vol: 3, page: 405, stat: Journal Article,

Hypertrophic pyloric stenosis in adults: radiographic features
Balthazar EJ
1983 Jul;78(7):449-453, American journal of gastroenterology
— id: 43905, year: 1983, vol: 78, page: 449, stat: Journal Article,

Abdominal complications of drug addiction: radiologic features
Balthazar EJ; Lefleur R
1983 Jul;18(3):213-220, Seminars in roentgenology
— id: 43906, year: 1983, vol: 18, page: 213, stat: Journal Article,

Radiographic diagnosis of Spigelian hernia
Balthazar EJ; Subramanyam BR
1983 Aug;78(8):525-528, American journal of gastroenterology
— id: 43903, year: 1983, vol: 78, page: 525, stat: Journal Article,

Computed tomography of gastrointestinal lymphoma
Megibow AJ; Balthazar EJ; Naidich DP; Bosniak MA
1983 Sep;141(3):541-547, American journal of roentgenology
From 275 computed tomographic (CT) examinations with positive findings of abdominal lymphoma, 26 patients were found to have gastrointestinal involvement by the disease. The stomach was most commonly involved, followed by small bowel, colon, and duodenum. CT was found to be accurate in detecting wall thickening and complications such as perforation and fistulization. False-negative examinations occurred in two patients with small submucosal gastric deposits ('bull's-eye' lesions). False-positive examinations were seen in two patients with hypertrophic gastritis. The CT manifestations of gastrointestinal lymphoma, correlated with the barium study appearance, are the subject of this report
— id: 43722, year: 1983, vol: 141, page: 541, stat: Journal Article,

Pathologic fracture in systemic mastocytosis. Radiographic spectrum and review of the literature
Rafii M; Firooznia H; Golimbu C; Balthazar E
1983 Nov;(180):260-267, Clinical orthopaedics & related research
Systemic mastocytosis is a multiorgan disease that most commonly affects the skin and skeletal system. Radiographically, the skeletal changes in the majority of patients consist of either a wide-spread mixture of bone lysis and osteosclerosis or generalized osteoporosis. The osteoporotic form is less well known but may lead to severe generalized demineralization and pathologic fractures. Mast cells secrete a number of substances, two of which (heparin and prostaglandins) are believed to have a role in the induction of osteoporosis. Sclerotic lesions are induced by another mast cell by-product, histamine. One hundred seventy-eight cases of bony mastocytosis have been reported in the literature, including the four patients in the present report. Special staining procedures are necessary for identification of mast cells. Diagnosis may be delayed in patients who do not have the skin lesions (urticaria pigmentosa) and in the osteoporotic form of the disease
— id: 47524, year: 1983, vol: , page: 260, stat: Journal Article,

Sonography of adenomyomatosis of the gallbladder: radiologic-pathologic correlation
Raghavendra BN; Subramanyam BR; Balthazar EJ; Horii SC; Megibow AJ; Hilton S
1983 Mar;146(3):747-752, Radiology
Sonograms of six patients with adenomyomatosis of the gallbladder were reviewed and correlated with oral cholecystographic and pathologic findings. The gallbladder was visualized in four of the six patients by oral cholecystography, which also revealed intramural diverticula. Five of the six patients showed sonographic evidence of diffuse or segmental thickening of the gallbladder wall and intramural diverticula, seen as anechoic or echogenic foci within the wall. Intramural diverticula containing bile appeared as anechoic spaces; those containing biliary sludge or gallstones appeared as echogenic foci with or without acoustic shadows or reverberation artifacts. There was good correlation between sonographic and pathologic findings in three patients. The authors conclude that adenomyomatosis of the gallbladder should be suspected when (a) there is diffuse or segmental thickening of the gallbladder wall and (b) intramural diverticula are seen as anechoic or echogenic foci with or without associated acoustic shadows or reverberation artifacts
— id: 43727, year: 1983, vol: 146, page: 747, stat: Journal Article,

Sonography of portosystemic venous collaterals in portal hypertension
Subramanyam BR; Balthazar EJ; Madamba MR; Raghavendra BN; Horii SC; Lefleur RS
1983 Jan;146(1):161-166, Radiology
Portosystemic venous collaterals were studied with sonography in 40 patients with known portal hypertension. Eight patients had technically inadequate scans, while 32 had optimal scans. Sixty groups of venous collaterals were identified. At least one collateral pathway was seen in 28 patients, for a sensitivity of 88% for the 32 patients with optimal scans and 70% for the total group. The overall sensitivity for detection of coronary-gastroesophageal collaterals was 80% and 64%, respectively. The small size of the coronary-gastroesophageal varices in early portal hypertension seems to be the most important factor limiting detection in patients suitable for sonography
— id: 23126, year: 1983, vol: 146, page: 161, stat: Journal Article,

Ruptured hydatid cyst with biliary obstruction: diagnosis by sonography and computed tomography
Subramanyam BR; Balthazar EJ; Naidich DP
1983 ;8(4):341-343, Gastrointestinal radiology
Communication between a hydatid cyst of the liver and the right hepatic duct resulted in biliary obstruction by the released cyst contents. Ultrasonography and computed tomography were utilized for preoperative diagnosis
— id: 43908, year: 1983, vol: 8, page: 341, stat: Journal Article,

Ultrasound analysis of solid-appearing abscesses
Subramanyam BR; Balthazar EJ; Raghavendra BN; Horii SC; Hilton S; Naidich DP
1983 Feb;146(2):487-491, Radiology
A retrospective review of 96 abdominal abscesses yielded 11 cases (9%) that were diffusely echogenic on sonograms and that stimulated findings of solid lesions. Sonographic features of these abscesses were analyzed and compared with features of 78 cases of hepatic metastasis. An abscess was considered solid appearing when it contained diffuse internal echoes that were distributed over 90% of the abscess cavity. The visualized internal echoes were of low to medium amplitude, and were generally similar to the normal echogenicity of the parenchymal organs, such as the liver, spleen, or uterus. Distal acoustic enhancement was seen in 91% of the solid abscesses, and it was not seen in hepatic metastases. A distinct echogenic wall was present in 64% of the abscesses (subacute and chronic lesions), but this occurred in less than 4% of metastases. Thin peripheral halos inside or outside of and adjacent to the abscess wall were seen in 36% of abscesses. The peripheral halos seen in metastases were wider and not associated with an echogenic wall. The diagnosis of a diffusely echogenic abscess and differentiation from a neoplasm is possible when the sonographic findings of acoustic enhancement, thin peripheral halo, and echogenic abscess wall are present
— id: 43907, year: 1983, vol: 146, page: 487, stat: Journal Article,

Sonographic evaluation of patients with portal hypertension
Subramanyam BR; Balthazar EJ; Raghavendra BN; Lefleur RS
1983 Jun;78(6):369-373, American journal of gastroenterology
The availability of real-time sonography has facilitated its use in the assessment of patients suspected of portal hypertension. Dilatation of the portal venous system may occur in portal hypertension, and a portal vein diameter greater than 13 mm is indicative of portal hypertension with a sensitivity of about 50%. Sonographic demonstration of lack of caliber variation of the portal system has a sensitivity of about 80%. The presence of venous collaterals can be demonstrated in about 90% of patients suitable for sonography. The coronary gastroesophageal varices can be seen in 90% when they are large sized, and in 65% when they are small sized. Other collaterals such as umbilical vein, duodenal varices, and gastrorenal and splenorenal varices can be detected. Sonography is a valuable screening procedure in the evaluation of portal hypertension and provides valuable information regarding the size and morphology of the liver and spleen, caliber and patency of the portal venous system, and the existence and location of the varices
— id: 23449, year: 1983, vol: 78, page: 369, stat: Journal Article,

Replacement lipomatosis of the kidney: diagnosis by computed tomography and sonography
Subramanyam BR; Bosniak MA; Horii SC; Megibow AJ; Balthazar EJ
1983 Sep;148(3):791-792, Radiology
The sonographic and computed tomographic features in a case of replacement lipomatosis of the kidney are presented, along with pathologic correlation. Computed tomography demonstrated a staghorn calculus and marked atrophy of the renal parenchyma, along with diffuse increase in renal sinus and perirenal fat. Sonography showed thinning of the renal parenchyma and high-amplitude echoes throughout the kidney, corresponding to the increase in renal sinus fat. The prospective diagnosis of replacement lipomatosis, and differentiation from other causes of nonfunction of the kidney due to staghorn calculus, can be readily made
— id: 43720, year: 1983, vol: 148, page: 791, stat: Journal Article,

Hematosalpinx in tubal pregnancy: sonographic-pathologic correlation
Subramanyam BR; Raghavendra BN; Balthazar EJ; Horii SC; Hilton S; Goldstein SR
1983 Aug;141(2):361-365, American journal of roentgenology
Review of sonograms in 84 patients with documented tubal pregnancies yielded 15 cases with discrete, diffusely echogenic, adnexal masses (18%). All these cases were proven at surgery to represent hematosalpinx containing clotted blood. The characteristic sonographic findings in these cases enabled an accurate preoperative diagnosis in 12 consecutive patients. Hematosalpinx containing clotted blood was seen as a diffusely echogenic adnexal mass accompanied in most cases by areas of high-intensity echoes. Pelvic hemoperitoneum (five cases) was diffusely echogenic due to clotted blood, and its recognition enabled evaluation of the upper abdomen for extension of hemorrhage. The echogenicity of the adnexal mass and pelvic hematoma was similar to that of the uterus, resulting in obscuration of its contour. The following sonographic features are characteristic of tubal pregnancy in the proper clinical setting: (1) absence of intrauterine gestation; (2) diffusely echogenic adnexal mass with areas of high-intensity echoes; and (3) diffusely echogenic hematoma in the pouch of Douglas
— id: 43904, year: 1983, vol: 141, page: 361, stat: Journal Article,

Gastric carcinoid tumors: radiographic features in eight cases
Balthazar EJ; Megibow A; Bryk D; Cohen T
1982 Dec;139(6):1123-1127, American journal of roentgenology
A retrospective analysis of eight proven cases of gastric carcinoid tumors is reported with emphasis on the radiographic features. These tumors occur rarely in the stomach and have variable radiographic presentations: (1) intramural defects simulating leiomyomas, (2) multiple gastric polyps, (3) large gastric ulcers, and (4) polypoid intraluminal lesions. In this series, single submucosal lesions located in the fundus and body of the stomach were demonstrated in five patients, adjacent sessile polyps in one patient, and large gastric ulcerations in the other two patients. In five of the cases, ulcerations were clearly visualized radiographically. Three patients had pathologic evidence of metastatic dissemination. The unusual entity of argentaffin-cell adenocarcinoma of the stomach is illustrated and discussed together with a pertinent review of the literature
— id: 43729, year: 1982, vol: 139, page: 1123, stat: Journal Article,

Diagnostic utility of sonography and computed tomography in spontaneous mesenteric hematoma
Raghavendra BN; Grieco AJ; Balthazar EJ; Megibow AJ; Subramanyam BR
1982 Aug;77(8):570-573, American journal of gastroenterology
— id: 18922, year: 1982, vol: 77, page: 570, stat: Journal Article,

Alimentary tract involvement in Kaposi sarcoma: radiographic and endoscopic findings in 25 homosexual men
Rose HS; Balthazar EJ; Megibow AJ; Horowitz L; Laubenstein LJ
1982 Oct;139(4):661-666, American journal of roentgenology
An outbreak of Kaposi sarcoma has recently occurred among young homosexual men. It differs from the classic form in its virulence and preponderance of systemic manifestations. Twenty-five homosexual men with a mean age of 37 and biopsy-proven Kaposi sarcoma received extensive gastrointestinal evaluations. Twelve patients (48%) had evidence of gastrointestinal involvement by radiography and/or endoscopy. Lesions were found in the larynx, oropharynx, esophagus, stomach, duodenum, and colon. Radiographically they ranged from minimally elevated submucosal lesions, some with central ulceration, to polypoid defects. Abdominal CT was obtained in 18 patients, 11 of whom showed abnormalities. Of those with abnormal CT, 50% had retroperitoneal adenopathy. The gastrointestinal radiographic findings with endoscopic correlation in this unusual group of patients is discussed
— id: 43731, year: 1982, vol: 139, page: 661, stat: Journal Article,

Sonographic diagnosis of scrotal hernia
Subramanyam BR; Balthazar EJ; Raghavendra BN; Horii SC; Hilton S
1982 Sep;139(3):535-538, American journal of roentgenology
— id: 43909, year: 1982, vol: 139, page: 535, stat: Journal Article,

Sonography of exophytic gastrointestinal leiomyosarcoma
Subramanyam BR; Balthazar EJ; Raghavendra BN; Madamba MR
1982 ;7(1):47-51, Gastrointestinal radiology
— id: 23128, year: 1982, vol: 7, page: 47, stat: Journal Article,

Gastrointestinal leiomyosarcoma--unusual sites: esophagus, colon and porta hepatis
Balthazar EJ
1981 ;6(4):295-303, Gastrointestinal radiology
This paper is based on a retrospective analysis of the radiologic findings of 6 newly proven cases of primary gastrointestinal leiomyosarcomas located in unusual sites. The radiographic and angiographic features of esophageal, colonic, and porta hepatis leiomyosarcomas are described and illustrated. General background information together with a brief review of the literature regarding these lesions are provided. The difficulties encountered in the preoperative diagnosis are explained by the protean and non-specific clinical and radiographic features of many of these tumors. In addition, although myomatous tumors of the liver and porta hepatis are angiographically hypervascular, similar tumors of the colon are slight to moderately vascular, and tumors of the esophagus are avascular
— id: 43911, year: 1981, vol: 6, page: 295, stat: Journal Article,

Hyperrugosity in gastric carcinoma: radiographic, endoscopic, and pathologic features
Balthazar EJ; Davidian MM
1981 Mar;136(3):531-535, American journal of roentgenology
The morphology of the rugal folds in carcinoma of the stomach is reviewed, with emphasis on the hyperrugosity of the diffusely infiltrating lesions. Six of the 27 patients with diffuse infiltrating lesions demonstrated atypical features and were misdiagnosed as benign gastropathies or lymphomas. In these six patients there was enlargement, irregularity, and tortuosity of the rugal folds with the preservation of a relatively normal gastric volume, distensibility, and peristaltic activity. The involvement was segmental or diffuse and ulcerations were observed on endoscopic and radiographic examinations in two of the cases. Deep endoscopic biopsies were successful in establishing a correct diagnosis in most of the cases. The pathologic correlation, pitfalls in the radiologic and endoscopic diagnosis, and a short review of the pertinent literature are presented
— id: 43910, year: 1981, vol: 136, page: 531, stat: Journal Article,

Segmental tuberculosis of the distal colon: radiographic features in 7 cases
Balthazar EJ; Bryk D
1980 Feb 1;5(1):75-80, Gastrointestinal radiology
The radiographic features of 7 cases of segmental colonic tuberculosis are described and illustrated. The lesions are generally short (5--7 cm) and may involve any part of the colon. They present radiographically as segmental granulomatous colitis or as annular, ulcerated lesions mimicking colonic carcinoma. Cases with sinus tract formation, severe narrowing, marked distortion, and fixation may occur. The association with pulmonary tuberculosis is common but not universal. The clinical findings are nonspecific, but the age group affected is mainly that of young adults. A short review of the pertinent literature is presented
— id: 43914, year: 1980, vol: 5, page: 75, stat: Journal Article,

Carcinoma of the esophagogastric junction
Balthazar EJ; Goldfine S; Davidian MM
1980 Sep;74(3):237-243, American journal of gastroenterology
We have reviewed and analyzed the clinical and radiographic features of 38 patients with proven carcinoma involving the esophagogastric junction. There were 29 cases of adenocarcinoma and nine of squamous cell carcinoma presenting with similar symptoms, surgical findings and radiographic characteristics. Features that suggest adenocarcinoma are: 1. mass or distortion of the gastric fundus; 2. short lesion; 3. smooth submucosal contour defect representing tumor undermining mucosa. Hiatus hernia was present in 17% of adenocarcinomas and 44% of epidermoid carcinomas but the association appears to be coincidental. Atypical forms of presentation such as lesions involving almost the entire esophagus or mimicking peptic esophagitis and achalasia are discussed and illustrated. Pertinent data from the literature is reviewed. In order to avoid errors in the roentgenographic diagnosis routine careful examination of the esophagogastric junction is recommended
— id: 43912, year: 1980, vol: 74, page: 237, stat: Journal Article,

Scirrhous carcinoma of the pyloric channel and distal antrum
Balthazar EJ; Rosenberg H; Davidian MM
1980 Apr;134(4):669-673, American journal of roentgenology
The clinical, endoscopic, and pathologic features of 13 cases of scirrhous carcinoma of the pyloric channel and distal antrum are described and correlated with the radiographic findings. The lesions appear as smooth concentric narrowings, rigid and generally short. They are associated with outlet obstruction but without gastric or duodenal ulcerations. Features highly suggestive of pyloric muscular hypertrophy, such as indentation at the base of the duodenal cap and pyloric notch, may occur. Almost all cases had serosal invasion and lymphatic spread at surgery. The differential diagnosis and a short review of the pertinent literature is presented
— id: 43913, year: 1980, vol: 134, page: 669, stat: Journal Article,

Effects of acute and chronic pancreatitis on the stomach patterns of radiographic involvement
Balthazar EJ
1979 Nov;72(5):568-580, American journal of gastroenterology
The radiographic gastric changes associated with acute and chronic pancreatitis are described. The pertinent literature is reviewed and forms of involvement previously not reported are illustrated and discussed. Intramural and perigastric permeation of extravasated pancreatic enzymes and the secondary inflammatory reaction that follows are responsible for the radiographic changes observed. Generalized rugal thickening and particularly a localized spiculated appearance to the posterior wall of the stomach are transitory findings seen in acute pancreatitis. Radiographic abnormalities associated with chronic pancreatitis include patterns mimicking linitis plastica, indurated and nondistensible rugae involving the proximal stomach and a severely distorted gastric configuration induced by perigastric adhesions. The recognition of these patterns of involvement helps in the radiographic diagnosis and avoids confusing or evasive interpretations
— id: 43915, year: 1979, vol: 72, page: 568, stat: Journal Article,

Radiographic examination of the stomach following surgery for pancreatic pseudocyst. A source of diagnostic error
Balthazar EJ
1979 Jan 30;4(1):23-28, Gastrointestinal radiology
The radiographic changes in the stomach following drainage procedures for pancreatic pseudocysts are described and illustrated. Principles of modern surgical techniques are reviewed and the occurrence and significance of barium reflux into the cyst are discussed. Contrary to previous statements, it is pointed out that reflux into the cyst may occur following Roux-en-Y cystojejunostomies. Radiographic presentations mimicking peptic ulcers, rigid gastric segments, and pseudodiverticula formation, related to the healing postoperative process, are emphasized
— id: 43919, year: 1979, vol: 4, page: 23, stat: Journal Article,

Primary and metastatic scirrrhous carcinoma of the rectum
Balthazar EJ; Rosenberg HD; Davidian MM
1979 May;132(5):711-715, American journal of roentgenology
Eight cases of scirrhous carcinoma of the rectum are described. Five patients had primary lesions and three had metastases from stomach and breast. Radiographic features were severe rectal narrowing, rigidity, and smooth contours or, more commonly, moderate narrowing, distorted nodular folds, and an irregular serrated contour mimicking inflammatory disease. Difficulties in the radiologic and histologic diagnosis and a short review of pertinent literature are reported
— id: 43918, year: 1979, vol: 132, page: 711, stat: Journal Article,

Malignant carcinoid of the appendix: case report with radiographic and angiographic demonstration
Goldfine SL; Balthazar EJ
1979 Jun;71(6):627-632, American journal of gastroenterology
An unusual case of a malignant carcinoid of the appendix is reported, together with a brief review of the pertinent literature. The case exhibited mesenteric invasion, peritoneal seeding, terminal ileal ischemia and features of the carcinoid syndrome. The radiographic and angiographic documentation are unique in the literature
— id: 43917, year: 1979, vol: 71, page: 627, stat: Journal Article,

Abnormalities of the bile duct associated with chronic pancreatitis
Siegel JH; Sable RA; Ho R; Balthazar EJ; Rosenthal WS
1979 Sep;72(3):259-266, American journal of gastroenterology
The association of abnormalities of the common bile duct with chronic inflammatory disease of the pancreas is described in this report in which the important diagnostic role of endoscopic retrograde cholangiopancreatography (ERCP) is emphasized in this disease entity. ERCP was utilized as a single diagnostic modality in 27 patients (15 females) in whom both the biliary tree and pancreatic ducts were demonstrated. Abnormalities of the pancreatic duct were noted in all patients while the associated changes of the common bile duct were noted in 12 (44%--7 females). The role of ERCP in confirming the diagnosis and its importance in planning specific therapy is emphasized
— id: 43916, year: 1979, vol: 72, page: 259, stat: Journal Article,

Carcinoid tumors of the alimentary tract. I. Radiographic diagnosis
Balthazar EJ
1978 Apr 15;3(1):47-56, Gastrointestinal radiology
This paper is based on a retrospective analysis of the radiographic findings in 18 new proven cases of carcinoids of the gastrointestinal tract. Examples of lesions involving different segments together with a detailed review of the pertinent literature are provided. Background information regarding the malignant potential of all carcinoids with particular reference to invasiveness, size, site, and symptomatology is discussed. Depending on the time of the examination during their development, carcinoids present either as smoothly defined, mostly small intramural nodules, or as large infiltrating and ulcerating malignant looking tumors. When mesenteric infiltration is present, a more specific combination of findings composed of submucosal nodules, separation of loops, and localized kinking may be seen. The demonstration of an isolated, sharply contoured defect does not exclude malignancy. The less common radiographic manifestations of tumoral calcifications and bony metastases are reviewed and illustrated
— id: 43922, year: 1978, vol: 3, page: 47, stat: Journal Article,

Air in gallbladder: a frequent finding in gallstone ileus
Balthazar EJ; Schechter LS
1978 Aug;131(2):219-222, American journal of roentgenology
A retrospective assessment of the presence of air in the biliary tract is presented, based on plain film findings in 16 proven cases of gallstone ileus. In addition to five cases that demonstrated air in the biliary radicles, four cases exhibited air exclusively in the gallbladder and duodenal bulb. A clearly identifiable radiographic appearance composed of two adjacent small air-fluid levels in the right upper quadrant is described. This radiographic feature represents the air- and fluid-filled duodenal cap adjacent to the visualized shrunken gallbladder. Recognition of this combination of findings helps in establishing a prompt preoperative diagnosis in cases of gallstone ileus
— id: 43920, year: 1978, vol: 131, page: 219, stat: Journal Article,

Carcinoid tumors of the alimentary tract. II. Angiographic diagnosis of small intestinal and colonic lesions
Kinkhabwala M; Balthazar EJ
1978 Apr 15;3(1):57-61, Gastrointestinal radiology
The angiographic findings of five small intestinal and two colonic carcinoids are described and illustrated, together with a review of the pertinent literature. It is pointed out that the demonstration of a complex of angiographic findings related to the primary site, mesentery, and liver is highly specific. It helps in the preoperative diagnosis as well as in the localization and stage of development of the gastrointestinal carcinoid. The triad of findings is composed of: (a) faint to moderate staining at the primary site; (b) narrowing, obstruction of the distal mesenteric arcade, cluster of irregular kinked vessels, and encasement in the more central areas of mesentery; and (c) hypervascular liver metastasis. The colonic lesions examined are unique in the literature, and exhibited angiographic findings similar to the small bowel carcinoids
— id: 43921, year: 1978, vol: 3, page: 57, stat: Journal Article,

Congenital positional anomalies of the colon: radiographic diagnosis and clinical implications. I. Abnormalities of rotation
Balthazar EJ
1977 Aug 18;2(1):41-47, Gastrointestinal radiology
Positional anomalies of the colon may be explained by an arrest in the normal development process of the distal midgut. Aberrations involving the incipient stages of rotation lead to severe malpositions, while those involving the latter stages to milder forms. The normal embryology of the distal (postarterial) segment, as well as forms of complete and partial nonrotations, are discussed and illustrated. A survey of 39 consecutive cases of rotational abnormalities of the midgut with special emphasis on the configuration of the colon is presented. There is a high incidence of associated failure of fixation resulting in mobile colons that can be demonstrated radiographically. In addition, the great majority of colonic malrotations demonstrate rotational abnormalities involving the proximal intestinal tract. Their clinical implication is related to the presence of other incidental congenital anomalies or to complications derived from faulty mesenteric fixations such as peritoneal bands, adhesions, kinking, or intestinal volvulus
— id: 43926, year: 1977, vol: 2, page: 41, stat: Journal Article,

Congenital positional anomalies of the colon: radiographic diagnosis and clinical implications. II. Abnormalities of fixation
Balthazar EJ
1977 Aug 18;2(1):49-56, Gastrointestinal radiology
Defective fixation during embryologic development is responsible for a variety of segmental colonic malpositions seen during barium enema examinations. A review of the normal development process of fixation is presented, together with the most common and significant aberrations. On the right side clinical entities such as axial torsion, cecal bascule, retrocolic sigmoid, and pericolic bands are discussed and illustrated. On the left side, the configuration and clinical implications of the malposition of the splenic flexure are analyzed. It is pointed out that reversed configurations of the splenic flexure associated with failure of fixation of the entire descending colon may occur as an isolated congenital abnormality and may not necessarily be associated with renal anomalies. The characteristic radiographic appearance of the persistent descending mesocolon and its potential for complications is in addition emphasized. Familiarization with the radiographic appearance and clinical implications of these common abnormalities is essential in the daily interpretation of barium enema examinations
— id: 43925, year: 1977, vol: 2, page: 49, stat: Journal Article,

Duodenal Hodgkin's disease
Balthazar EJ
1977 ;68(3):306-311, American journal of gastroenterology
An unusual case of primary extranodal Hodgkin's disease, localized to the duodenum is reported and illustrated. A review of the literature stressing the incidence, clinical presentation, radiographic appearance and prognosis of primary gastrointestinal Hodgkin's disease is presented. It is pointed out that although the majority of the lesions are infiltrating in type, intestinal Hodgkin's may present as a solitary ulceration or as a polypoid lesion indistinguishable from other forms lymphoma
— id: 43929, year: 1977, vol: 68, page: 306, stat: Journal Article,

Esophagobronchial fistula secondary to ruptured traction diverticulum
Balthazar EJ
1977 Oct 25;2(2):119-121, Gastrointestinal radiology
An unusual complication of benign esophagobronchial fistula, secondary to a ruptured esophageal traction diverticulum, is reported and illustrated. The patient presented with a history of chronic, recurrent bronchitis and intermittent episodes of paroxysmal attacks of coughing and strangling on the ingestion of fluids (Ono's sign). A review of the literature with emphasis on the occurrence, pathogenesis, radiographic features, and clinical implications of esophageal traction diverticula is presented
— id: 43924, year: 1977, vol: 2, page: 119, stat: Journal Article,

Hemobilia: calcified hepatic artery aneurysm presenting with massive gastrointestinal bleeding
Balthazar EJ
1977 Aug 18;2(1):71-74, Gastrointestinal radiology
A case of a calcified and ruptured hepatic artery aneurysm presenting with hemobilia and massive gastrointestinal bleeding is reported and illustrated. The clinical diagnosis should be entertained whenever the triad of findings (abdominal colic, gastrointestinal bleeding, elevated bilirubin levels) is present. Angiography is the method of choice in confirming this diagnosis. A short review of the clinical and radiographic syndrome of hemobilia with emphasis on the occurence, significance, and prognosis of hepatic artery aneurysms is presented
— id: 43927, year: 1977, vol: 2, page: 71, stat: Journal Article,

The radiology corner. Pseudomyxoma peritonei, clinical and radiographic features
Balthazar EJ; Javors BR
1977 Nov;68(5):501-509, American journal of gastroenterology
— id: 43923, year: 1977, vol: 68, page: 501, stat: Journal Article,

The radiology corner: Kaposi's sarcoma of the stomach
Balthazar EJ; Richman A
1977 Apr;67(4):375-379, American journal of gastroenterology
Kaposi's sarcoma is a systemic, multicentric and slowly progressing vascular tumor which usually affects the skin. Visceral involvement is common, may follow or precede the cutaneous involvement and rarely, may be the only manifestation of the disease. Gastric sarcomatous lesions are characterized by the presence of multiple submucosal or intraluminal nodules affecting a part or the entire stomach and simulating large gastric rugae. A case of isolated gastric Kaposi's sarcoma affecting the greater curvature of the stomach is presented, illustrated and discussed together with a short review of the pertinent literature
— id: 43928, year: 1977, vol: 67, page: 375, stat: Journal Article,

Intestinal malrotation in adults. Roentgenographic assessment with emphasis on isolated complete and partial nonrotations
Balthazar EJ
1976 Feb;126(2):358-367, American journal of roentgenology
Intestinal malrotation may occur as an isolated deformity. It may involve either the proximal (duodenojejunal) or the distal (cecocolic) intestinal segment. A survey of 28 consecutive cases of rotational abnormalities in the adult population demonstrates a diversity of roentgenographic presentations. Twelve cases exhibited the classical form of nonrotation of the entire midgut. The rest showed isolated forms of complete and partial rotations as well as a variety of intermediary forms previously not reported in the literature. Familiarization with this concept avoids confusing interpretations and errors in the roentgenographic diagnosis
— id: 43935, year: 1976, vol: 126, page: 358, stat: Journal Article,

Intramural gastrointestinal hemorrhage. Clinical and radiographic manifestations
Balthazar EJ; Einhorn R
1976 Nov 30;1(3):229-239, Gastrointestinal radiology
The clinical and radiographic manifestations of intramural gastrointestinal hemorrhage are presented together with a review of the literature. The observations described are based on the analysis of 20 cases affecting different segments of the gastrointestinal tract. The pathologic process is induced principally by anticoagulant therapy, bleeding diathesis, or abdominal trauma and occurs as a localized, well-defined, intramural mass or as a more diffuse segmental involvement. The clinical features are nonspecific and can vary from mild crampy abdominal pain to severe shock. Other manifestations include rebound tenderness, muscle guarding, and small bowel obstruction. The duodenum and small bowel are the most frequent sites of involvement. The intestinal mucosal folds may be prominent, stretched, and sharply defined or completely affaced, accompanied by a smooth narrowing. There is rapid clinical and radiographic remission with conservative therapy. Intestinal perforations and fibrotic strictures resulting in small bowel obstruction are a rarity, observed only in the posttraumatic variety
— id: 43931, year: 1976, vol: 1, page: 229, stat: Journal Article,

The normal and abnormal development of the appendix. A radiographic assessment
Balthazar EJ; Gade M
1976 Dec;121(3 Pt. 1):599-604, Radiology
Radiographic examinations of the colon in the adult demonstrate a wide variety of contours of the interior cecal segment and appendix. These findings are a result of the normal developmental process of the appendix which can be arbitrarily separated into four stages. Examples of appendiceal development arrested at different stages, as well as variations of the normal adult appendix, are explained and illustrated. Forms of primitive development and lack of development (agenesis) are discussed
— id: 43930, year: 1976, vol: 121, page: 599, stat: Journal Article,

Gastrointestinal edema in cirrhotics. Radiographic manifestations and pathogenesis with emphasis on colonic involvement
Balthazar EJ; Gade MF
1976 Nov 30;1(3):215-223, Gastrointestinal radiology
The radiologic manifestations of gastrointestinal edema observed as a complication of liver cirrhosis are described. We reviewed 22 consecutive patients with colonic and small bowel edema and present forms of intestinal involvement previously not reported. The pathophysiology of bowel edema is discussed and an attempt is made to correlate several factors. Our studies suggest that the production of intestinal edema is the result of a complex mechanism involving multiple factors on both sides of the capillary membrane. What appears crucial is not the absolute level of any disruptive force, but rather, the combination of several factors: 1. the ability of the lymphatic system to handle excessive flow; 2. the oncotic pressure; 3. the hydrostatic pressure and portal hypertension with or without venous collaterals. In this context, portal hypertension seems to play a dominant role since it correlates best with intestinal edema and explains its usual distribution
— id: 43932, year: 1976, vol: 1, page: 215, stat: Journal Article,

Cholecystoenteric fistulas:s ignificance and radiographic diagnosis
Balthazar EJ; Gurkin S
1976 Feb;65(2):168-173, American journal of gastroenterology
Cholecystoenteric fistulas, not associated with gallstone ileus syndrome, are relatively common complications occurring during the natural history of cholelithiasis and cholecystitis. The etiology, pathogenesis as well as common and uncommon forms of gallbladder fistulas are presented and discussed. The roentgenographic findings are reviewed and a simple classification into two major groups is offered. The majority are acute, transitory, short-lived fistulas, which are self-limiting and relatively common events that usually remain undiagnosed. A minority fail to heal, become chronic and permanent fistulas and are associated with obstruction of the common duct
— id: 43933, year: 1976, vol: 65, page: 168, stat: Journal Article,

Radiological signs of acute pancreatitis
Balthazar EJ; Lutzker S
1976 Feb;7(3):199-242, CRC critical reviews in clinical radiology & nuclear medicine
Acute pancreatitis is commonly presented as a confusing and challenging diagnostic problem. This article is intended to show the increasingly important contribution radiology plays in the establishment of a correct initial diagnosis as well as in recognizing the serious complications of acute pancreatitis. A short discussion of the etiology and pathophysiology of pancreatitis is essential in understanding the mechanism of production of the X-ray findings. The most important recently published papers on this topic are reviewed together with a personal evaluation of the most significant and reliable radiographic changes. Statistical data, indications, and contraindications as well as the limitations of our radiographic procedures are discussed
— id: 43934, year: 1976, vol: 7, page: 199, stat: Journal Article,

The Mirizzi syndrome, inflammatory structure of the common hepatic duct
Balthazar EJ
1975 Aug;64(2):144-148, American journal of gastroenterology
— id: 43939, year: 1975, vol: 64, page: 144, stat: Journal Article,

The radiology corner. Gastric myeloma
Balthazar EJ; Cano R
1975 Apr;63(4):340-344, American journal of gastroenterology
Gastric myeloma is a rare malignant tumor composed of atypical plasma cells and represents, as a rule, only the initial manifestation of widespread myelomatous proliferation. Roentgenographically, it may be indistinguishable from carcinoma of the stomach or it may present as a large intramural mass, often situated along the greater curvature of the stomach. The association of a malignant looking gastric lesion with clinical or radiographic evidence of multiple myeloma should strongly suggest the diagnosis
— id: 43940, year: 1975, vol: 63, page: 340, stat: Journal Article,

Jejunileal bypass. Roentgenographic observations
Balthazar EJ; Goldfine S
1975 Sep;125(1):138-142, American journal of roentology, radium therapy, & nuclear medicine
Jejunioleal bypass procedures may be performed with the bypassed small intestine draining, as usual, into the cecum, or with end-to end anastomosis of the jejunum and terminal ileum, with the bypassed segment draining into the transverse colon through another anastomosis. Modifications of these methods have also beed devised. After good response with weight loss initially, most patients fail to continue to lose weight into the third year postoperatively. Some of the features which cause failure are: prolonged transit time, intestinal dilatation with mucosal hypertrophy, and reflux into the bypassed segment, in the earlier type of operation
— id: 43938, year: 1975, vol: 125, page: 138, stat: Journal Article,

The radiology corner. Anorectal melanoma
Balthazar EJ; Javors B
1975 Jan;63(1):79-83, American journal of gastroenterology
A case of malignant anorectal melanoma is presented together with a short review of the literature. The lesion arises from the melanocytes normally present within the squamous epithelium of the anal canal. It presents as a small polypoid tumor and spreads rapidly into rectum, perirectal tissues, pelvic and inguinal nodes. It should be considered in the differential diagnosis of sessile lesions located or involving the anal canal
— id: 43941, year: 1975, vol: 63, page: 79, stat: Journal Article,

The radiology corner. Malignant melanoma of the gallbladder
Balthazar EJ; Javors B
1975 Oct;64(4):332-335, American journal of gastroenterology
An unusual case of melanoma of the gallbladder is reported. It is the fourth reported case with roentgenographic demonstration. It presented clinically as cholecystitis and radiologically as a larger solitary defect within the gallbladder accompanied by cholelithiasis. It is probably a metastatic deposit although no other metastases were demonstrated
— id: 43937, year: 1975, vol: 64, page: 332, stat: Journal Article,

Gallstone ileus. The importance of contrast examinations in the roentgenographic diagnosis
Balthazar EJ; Schechter LS
1975 Oct;125(2):374-379, American journal of roentology, radium therapy, & nuclear medicine
Our experience based on the analysis of 12 proved cases of gallstone ileus is presented emphasizing the fact that the plain abdominal roentgenogram may be inconclusive or deceiving. It allowed us to suggest the correct diagnosis in only 4 cases. A high index of suspicion, particularly in elderly female patients, followed by barium examination of the upper gastrointestinal tract leads to a correct and rapid diagnosis. The demonstration of a diverticulum-like structure or a fistulous tract adjacent to the first portion of the duodenum associated with jejunal dilatation and barium dilution is highly reliable
— id: 43936, year: 1975, vol: 125, page: 374, stat: Journal Article,

Inflammatory pseudotumours of the lung
Strutynsky N; Balthazar EJ; Klein RM
1974 Feb;47(554):94-96, British journal of radiology
— id: 43942, year: 1974, vol: 47, page: 94, stat: Journal Article,

Angiographic manifestationsof cardiac trauma
Moskowitz, H; Smith, E H; Balthazar, E J
1971 Feb 1;71(3):345-349, New York state journal of medicine
— id: 43943, year: 1971, vol: 71, page: 345, stat: Journal Article,