1979, British Journal of Radiology, 52, 149-150
FEBRUARY 1979
Case reports Selective angiography of the splenic artery confirmed the splenomegaly and showed that the entire spleen was involved with stretched intraparenchymatous arteries displaced around avascular areas. No encasement or tumour vessels were seen (Fig. 1). The late phase of the angiogram disclosed irregular contrast accumulation with multiple avascular defects throughout the spleen (Fig. 2). The patient underwent splenectomy and recovery was uneventful. The specimen consisted of the spleen which weighed 1.300 g and showed a "swiss cheese" appearance with multiple small cysts containing watery fluid. Flattened endothelial cells lined the cysts. The diagnosis of cystic lymphangioma of the spleen was made.
which have been described previously (Shanser et al., 1973; Tuttle and Minielly, 1978). From now this entity should be considered in the differential diagnosis of splenomegaly. Only angiography can disclose the nature of splenic enlargement and show the changes of cystic lymphangioma of the spleen, allowing the correct pre-operative diagnosis. ACKNOWLEDGMENTS
We wish to thank Prof. Trygve Aakhus for his kind permission to use this case from his department.
DISCUSSION
The signs and symptoms of lymphangioma of the spleen are not distinctive and only splenomegaly is evident. The true incidence is not known and authors are unable to indicate the aetiology (McClure and Altemeier, 1942). Few cases of lymphangiomatous cysts of the spleen have been angiographically examined. According to the literature the angiographic pattern is characteristic. The present case showed the same widespread arterial changes and avascular defects
REFERENCES EKELUND, L., GOTHLIN, J., and PETTERSSON, H.,
1975.
Angiography in expansile lesions of the spleen. Ada Radiologica, 125, 81-90. MCCLURE, R. D., and ALTEMEIER, W. A., 1942. Cysts of the
spleen. Annals of Surgery, 116, 98-102. SHANSER, J. D., MOSS, A. A., and CLARCK, R. E., 1973.
Angiographic evaluation of cystic lesions of the spleen. American Journal of Roentgenology, 119, 166-174. TUTTLE, R. J., and MINIELLY, J. A., 1978. Splenic cystic
lymphangiomatosis: an unusual cause of splenomegaly. Radiology, 126,47-48.
The build up of technetium in breast milk following the administration of "TcmO4 labelled macroaggregated albumin By B. Heaton, M.Sc, M.lnst.P. Department of Bio-medical Physics and Bio-engineering, University of Aberdeen {Received February, 1978 and in revised form April, 1978)
When " T c m 0 4 labelled macroaggregated albumin is administered to a lactating mother it may be necessary to delay the resumption of feeding. This can cause various problems including the discomfort experienced by the mother and a possible reaction by the child. The practice in Aberdeen, in the few cases experienced, has been to recommend a delay of 36 hours following an administered dose of 500 /xCi before feeding is resumed. In a recent review article (Anderson, 1977) on drugs and breast feeding it was suggested that it would be safe to resume feeding after 24 hours. The work quoted (Berke et al., 1971) dealt with a dose administered to a mother who had been feeding her child for six months.
could then be compared with those of Berke and the suitability of the 24 hour delay checked. Starting two hours after the injection of 500^Ci at 16.00 h, samples were expressed at four hourly intervals except during the period 22.00 h to 06.00 h. These were counted e
©Physical decay of "
m
Tc
• Concentration in milk for an administered dose of 500JJG Berke's data
10-
Concentration in milk for an administered dose of 500pC from Table 1
nCi/ml
CASE REPORT
This paper concerns a mother who was referred for a lung scan almost immediately following the birth of her child. The mother wished to start feeding the child soon after the scan as she had successfully fed her two previous children. As this case was unusual in that feeding had not yet commenced and the mother was willing to co-operate, it was decided to monitor the build up and fall of technetium in expressed samples, firstly of colostrum and later of milk. These data
30 20 Time after injection (Hrs)
FIG. 1. Comparison of activity concentration in expressed milk samples.
149
1979, British Journal of Radiology, 52,150-152 Case reports
TABLE I ACTIVITIES OF EXPRESSED SAMPLES
Breast
Vol., ml.
Collection time after injection, hours
1 2
Right Left
3 2
2 2
6.54x104 6.19x104
1.16
3 4
Right Left
1 1.75
6 6
4.44x104 6.04x104
1.74
5 6
Right Left
0.75 0.75
14 14
2.78x104 2.48x104
1.60
7 8
Right Left
5 4
18 18
1.89X1055 1.21 X10
1.57
9
Both
7
22
2.16X105
1.40
10
Both
8
26
1.90x105
1.09
Sample No.
11
Both
12 13
Right Left
3.8
20 20
Count in 1200 sec corrected to time of collection
Activity, nCi/ml.
4
38
2.1 x10
46 46
4.08x104 3.85x104
0.25 0.09
Background: 760 counts in 1200 sec. and the count rates adjusted to the count rate at the time of collection. Variation in efficiency due to counting samples of different volume were also accommodated. Using a standard, the activities of the samples were then calculated. Our results are compared with those of Berke (adjusted to an administered dose of 500/iCi) in Fig. 1. The results are given in Table I. DISCUSSION
The large initial difference in the two sets of data is probably due to different rates of breakdown of the macroaggregate. In that used by Berke, breakdown could have been so rapid that the maximum output occurred sometime before the first sample at four hours, whereas in our case technetium was apparently being made available for some 20 hours after the injection. Further work is now being undertaken to check this. There is also a difference in the type of sample collected over the first 20 hours following the injection. The samples collected by Berke were full milk samples. Those collected in Aberdeen were at
first nearly all colostrum and it was not until about 20 hours following the injection that the milk content started to rise. Despite the large differences in output noted above, the conclusion drawn by Berke that feeding could be resumed 24 hours after the injection is still valid and will be adopted in future. If this procedure is followed the whole-body dose to the baby would be something less than 0.05 millirem and that to the thyroid some 20 times higher. The dose to the baby due to its close proximity to the mother in the period following the injection would be larger but still only a few millirem. REFERENCES ANDERSON, P., 1977. Drugs and breast feeding—a review. Drug Intelligence and Clinical Pharamcology, 11, 208-223. BERKE, R. A., HOOPS, E. C , KEREIAKES, J. C , and SAENGER,
E. L., 1971. Radiation dose to breast feeding child after mother had 99mTc-MAA lung scan. Journal of Nuclear Medicine, 74,51-52.
Demonstration of a patent porta-caval anastomosis by ultrasound By K. C. Dewbury, B.Sc, F.R.C.R., and A. E. A. Joseph, M.Sc, F.R.C.R. Radiology Department, Southampton General Hospital, Southampton The portal venous system is almost always visualized in ultrasound images of the upper abdomen. In portal hypertension the increased diameter of the portal vein may be measured on ultrasound images (Doust and Pearce, 1976). This measurement may
be of value both in diagnosis and follow-up of patients. In portal vein thrombosis the normal vascular anatomy at the porta hepatis is replaced by a broad band of high level echoes. The appearance is characteristic (Webb et al., 1977). A case is presented
150
FEBRUARY 1979
Case reports Selective angiography of the splenic artery confirmed the splenomegaly and showed that the entire spleen was involved with stretched intraparenchymatous arteries displaced around avascular areas. No encasement or tumour vessels were seen (Fig. 1). The late phase of the angiogram disclosed irregular contrast accumulation with multiple avascular defects throughout the spleen (Fig. 2). The patient underwent splenectomy and recovery was uneventful. The specimen consisted of the spleen which weighed 1.300 g and showed a "swiss cheese" appearance with multiple small cysts containing watery fluid. Flattened endothelial cells lined the cysts. The diagnosis of cystic lymphangioma of the spleen was made.
which have been described previously (Shanser et al., 1973; Tuttle and Minielly, 1978). From now this entity should be considered in the differential diagnosis of splenomegaly. Only angiography can disclose the nature of splenic enlargement and show the changes of cystic lymphangioma of the spleen, allowing the correct pre-operative diagnosis. ACKNOWLEDGMENTS
We wish to thank Prof. Trygve Aakhus for his kind permission to use this case from his department.
DISCUSSION
The signs and symptoms of lymphangioma of the spleen are not distinctive and only splenomegaly is evident. The true incidence is not known and authors are unable to indicate the aetiology (McClure and Altemeier, 1942). Few cases of lymphangiomatous cysts of the spleen have been angiographically examined. According to the literature the angiographic pattern is characteristic. The present case showed the same widespread arterial changes and avascular defects
REFERENCES EKELUND, L., GOTHLIN, J., and PETTERSSON, H.,
1975.
Angiography in expansile lesions of the spleen. Ada Radiologica, 125, 81-90. MCCLURE, R. D., and ALTEMEIER, W. A., 1942. Cysts of the
spleen. Annals of Surgery, 116, 98-102. SHANSER, J. D., MOSS, A. A., and CLARCK, R. E., 1973.
Angiographic evaluation of cystic lesions of the spleen. American Journal of Roentgenology, 119, 166-174. TUTTLE, R. J., and MINIELLY, J. A., 1978. Splenic cystic
lymphangiomatosis: an unusual cause of splenomegaly. Radiology, 126,47-48.
The build up of technetium in breast milk following the administration of "TcmO4 labelled macroaggregated albumin By B. Heaton, M.Sc, M.lnst.P. Department of Bio-medical Physics and Bio-engineering, University of Aberdeen {Received February, 1978 and in revised form April, 1978)
When " T c m 0 4 labelled macroaggregated albumin is administered to a lactating mother it may be necessary to delay the resumption of feeding. This can cause various problems including the discomfort experienced by the mother and a possible reaction by the child. The practice in Aberdeen, in the few cases experienced, has been to recommend a delay of 36 hours following an administered dose of 500 /xCi before feeding is resumed. In a recent review article (Anderson, 1977) on drugs and breast feeding it was suggested that it would be safe to resume feeding after 24 hours. The work quoted (Berke et al., 1971) dealt with a dose administered to a mother who had been feeding her child for six months.
could then be compared with those of Berke and the suitability of the 24 hour delay checked. Starting two hours after the injection of 500^Ci at 16.00 h, samples were expressed at four hourly intervals except during the period 22.00 h to 06.00 h. These were counted e
©Physical decay of "
m
Tc
• Concentration in milk for an administered dose of 500JJG Berke's data
10-
Concentration in milk for an administered dose of 500pC from Table 1
nCi/ml
CASE REPORT
This paper concerns a mother who was referred for a lung scan almost immediately following the birth of her child. The mother wished to start feeding the child soon after the scan as she had successfully fed her two previous children. As this case was unusual in that feeding had not yet commenced and the mother was willing to co-operate, it was decided to monitor the build up and fall of technetium in expressed samples, firstly of colostrum and later of milk. These data
30 20 Time after injection (Hrs)
FIG. 1. Comparison of activity concentration in expressed milk samples.
149
1979, British Journal of Radiology, 52,150-152 Case reports
TABLE I ACTIVITIES OF EXPRESSED SAMPLES
Breast
Vol., ml.
Collection time after injection, hours
1 2
Right Left
3 2
2 2
6.54x104 6.19x104
1.16
3 4
Right Left
1 1.75
6 6
4.44x104 6.04x104
1.74
5 6
Right Left
0.75 0.75
14 14
2.78x104 2.48x104
1.60
7 8
Right Left
5 4
18 18
1.89X1055 1.21 X10
1.57
9
Both
7
22
2.16X105
1.40
10
Both
8
26
1.90x105
1.09
Sample No.
11
Both
12 13
Right Left
3.8
20 20
Count in 1200 sec corrected to time of collection
Activity, nCi/ml.
4
38
2.1 x10
46 46
4.08x104 3.85x104
0.25 0.09
Background: 760 counts in 1200 sec. and the count rates adjusted to the count rate at the time of collection. Variation in efficiency due to counting samples of different volume were also accommodated. Using a standard, the activities of the samples were then calculated. Our results are compared with those of Berke (adjusted to an administered dose of 500/iCi) in Fig. 1. The results are given in Table I. DISCUSSION
The large initial difference in the two sets of data is probably due to different rates of breakdown of the macroaggregate. In that used by Berke, breakdown could have been so rapid that the maximum output occurred sometime before the first sample at four hours, whereas in our case technetium was apparently being made available for some 20 hours after the injection. Further work is now being undertaken to check this. There is also a difference in the type of sample collected over the first 20 hours following the injection. The samples collected by Berke were full milk samples. Those collected in Aberdeen were at
first nearly all colostrum and it was not until about 20 hours following the injection that the milk content started to rise. Despite the large differences in output noted above, the conclusion drawn by Berke that feeding could be resumed 24 hours after the injection is still valid and will be adopted in future. If this procedure is followed the whole-body dose to the baby would be something less than 0.05 millirem and that to the thyroid some 20 times higher. The dose to the baby due to its close proximity to the mother in the period following the injection would be larger but still only a few millirem. REFERENCES ANDERSON, P., 1977. Drugs and breast feeding—a review. Drug Intelligence and Clinical Pharamcology, 11, 208-223. BERKE, R. A., HOOPS, E. C , KEREIAKES, J. C , and SAENGER,
E. L., 1971. Radiation dose to breast feeding child after mother had 99mTc-MAA lung scan. Journal of Nuclear Medicine, 74,51-52.
Demonstration of a patent porta-caval anastomosis by ultrasound By K. C. Dewbury, B.Sc, F.R.C.R., and A. E. A. Joseph, M.Sc, F.R.C.R. Radiology Department, Southampton General Hospital, Southampton The portal venous system is almost always visualized in ultrasound images of the upper abdomen. In portal hypertension the increased diameter of the portal vein may be measured on ultrasound images (Doust and Pearce, 1976). This measurement may
be of value both in diagnosis and follow-up of patients. In portal vein thrombosis the normal vascular anatomy at the porta hepatis is replaced by a broad band of high level echoes. The appearance is characteristic (Webb et al., 1977). A case is presented
150
