Percutaneous ultrasound-guided fine-needle aspiration of adrenal gland lesions appears to be relatively safe, even in phaeochromocytoma, but further data are required to lend more weight to this finding. Minimally invasive aspirates could be considered as part of the diagnostic algorithm in the investigation of an incidentally detected adrenal gland lesion of uncertain clinical significance.

Since the introduction of iodized oil for routine bronchography in 1922 there have been several reports of untoward reactions following the procedure, and a fewA, were fatal. This is a report of another fatality from what is now considered to be a minor investigation.CASE REPORT A woman, aged 40 years, was admitted for investigation of an illness of two months' duration, characterized by left-sided pleuritic pain, dyspnoea, and cough with sputum which was blood-stained on one occasion. There was associated myxoedema which had been treated with a thyroid gland preparation for six years, and also a refractor-y anaemia of two years' duration.On admission the patienit's only symptom was dyspnioea. She was an obese woman with a slightly lemon-coloured skin, and minimal clubbing of the fingers. There was dullness and diminished air entry at the base of the left lung. On l adioscopy the diaphragm was mobile. Radiography showed atelectasis and consolidation at the base of the left lung. Bronchoscopy showed a dilatable stenosis of the left main stem bronchus.At this stage it was considered that the probable diagnosis was that of bronchogenic carcinoma of the left lower lobe, although bronchoscopy had proved inconclusive. it was decided that a bronchogram should be done in an attempt to confirm the diagnosis.At 11 a.m. on February 8, 1950, a left-sided bronchogram was carried out by injecting 14 ml. of iodized oil through the crico-thyroid membrane. This showed a normal bronchial tree.On the afternoon of the first day, four hours after bronchography, the patient developed a severe coryza arid lacrimation with dyspnoea, difficulty in talking, and increased cough and spLItum. On the second day small, red-brown macules appeared first on the forearms and, on the third and fourth days, on the face, nose, tongue, and under the chin. Within 24 to 48 hours the macules had become papLIlar, then vesicular, and finally pustular. The vesicles and the pustules were umbilicated. The pustules on direct examination and cuLlture contained a penicillin-sensitive strain of Staphi. aureus. The skin reaction was associated with a pyrexia ranging from 99.2°to 101°F.. and the signs of acute bronchitis, laryngitis, and pharyngitis. Radiography on the second day after bronchography showed the presence of opaque oil in the left lower lobe, but not in the stomach.On the fourth day a severe purulent conjLinctivitis developed. At this time the tongue became oedematous and shortly afterwards pustules similar to those upon the skin appeared on it. On the sixth day the pustules upon the face, nose, anld forearms began to coalesce and to break down, leaving large red, granulomatous areas, particularly on the extensor surfaces of the forearms. The nose, especially in the region of the ala nasae, was covered in pustules which burst and discharged leaving a slowly progressive erosion of the nares. The patient was seriously ill with an intermittent fever up to 102°F. and the pulse rate ranged between 130 and 140. The white blood on 10 May 2018 by guest. Prot...

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