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The authors describe four patients with Budd-Chiari syndrome in whom contrast material-enhanced computed tomographic (CT) scans demonstrated low-density venous thrombosis in three sites not, to our knowledge, previously described with this modality. Thrombosis was seen in the portal circulation, the hepatic veins, and the intrahepatic inferior vena cava. It is known that concomitant portal vein thrombosis may be seen in 20% of patients with Budd-Chiari syndrome. Three of the four patients in the current study had this finding, one with extensive thrombosis of portal, mesenteric, and splenic veins and the other two with portal vein branch involvement. In one patient hepatic vein thrombosis was demonstrated with CT, and in three inferior vena cava clot was demonstrated. All four patients had the distinctive hepatic parenchymal contrast enhancement pattern seen in this condition, which the authors think may be at least partially caused by associated portal thrombosis. The presence of portal venous thrombosis should prompt the observer to consider the diagnosis of Budd-Chiari syndrome. Detection of hepatic vein clot confirms the diagnosis and may be seen in this condition in association with inferior vena cava thrombus.

Computed tomography (CT) was performed in 20 patients with localized prostatic carcinoma before and after interstitial implantation of 125I seeds. Scans were analyzed to determine prostate volume, seed location, tumor response, and periprostatic tumor spread. CT volumes were an average of 25-30% greater than clinical estimates. In addition, CT demonstrated errors in implantation, including inhomogeneous distribution and extraprostatic seeds, in 17 patients (85%). Serial post-implantation scans showed no change in prostate volume in 12 patients (60%), a decrease in 7 (35%), and an increase in 1 (5%), concurring with clinical assessment of response to therapy. In 2 patients, clinically unsuspected tumor spread was identified on the CT scan.

The abdominal sonograms of 64 leukemic children were reviewed and correlated with clinical, hematological, and, when available, autopsy findings. Sonographic abnormalities including enlargement of the liver, spleen, pancreas, and kidneys, with or without alteration of parenchymal echo architecture, hydronephrosis, lymphadenopathy, and ascites were encountered in 70% of the patients. Ultrasound proved useful in detecting occult visceral leukemia and relapse, monitoring tumor response to chemotherapy, and assessing the complications of chemotherapy. Ultrasound is recommended for the routine evaluation and follow-up of the pediatric leukemic patient.

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