Nontraumatic Spontaneous Rupture of the Kidney: Etiology and CT Findings

PURPOSE: To evaluate the usefulness of CT scanning in determining the etiology of spontaneous rupture of the kidney. MATERIALS AND METHODS: We retrospectively analyzed the CT findings of spontaneous rupture of the kidney in eleven patients, Four were male and seven were female, and they were aged between 20 and 71 (mean, 46.6) years. Both pre- and post-contrast enhanced CT scanning was performed in all patients. RESULTS: Spontaneous renal rupture was induced in seven cases by neoplasms (three angiomyolipomas, three renal cell carcinomas, and one metastatic choriocarcinoma), in three cases by infection or inflammation (acute and chronic pyelonephritis, and renal abscess), and in one, by renal cyst. Common CT findings of rupture of the kidney were the accumulation of high density fluid in the perirenal and anterior pararenal space, and in homogeneous irregular low density of renal parenchyma and the rupture site. Angoimyolipoma showed fat and an angiomatous component in the lesion, while acute and chronic pyelonephrities revealed thinning of the renal parenchyma and an irregular renal outline. Renal cell carcinoma showed a dense soft tissue mass in the parenchyma. Well-defined, round low-density lesions were noted in the case of renal cyst and renal abscess. CONCLUSION: CT is very useful in diagnosing and determining the etiology of non-traumatic spontaneous rupture of the kidney and plays an important role in the evaluation of emergency cases.

Extrahepatic Metastasis of Peripheral Cholangiocarcinoma: CT Findings

PURPOSE: To evaluate the extrahepatic spread of peripheral cholangiocarcinoma with CT. MATERIALS AND METHODS: We retrospectively reviewed CT findings of extrahepatic spread in thirty-six patients with peripheral cholangiocarcinoma confirmed adenocarcinoma at surgery(n=5) or percutaneous biopsy(n--31) without primary leion in other organs, and analysed the frequency and distribution of enlarged lymph nodes, direct invasion of adjacent solid organs, and thrombosis of major vessels. RESULTS: Among the 36 cases, enlarged metastatic lymph node was noted in twenty-four(66.7%), direct invasion into adjacent organs in six(16.7%), portal and inferior vena caval thrombosis in five(13.9%). Enlarged lymph nodes were seen in hepatic nodes(n=16, 44.4%), portocaval nodes(n=15, 41.7%), interaortocaval nodes (n=10, 27.8) and celiac nodes in two(5.6%). Direct invasion was detected in the greater omentum(n=6), gallbladder(n:3) and stomach(n=2). Portal vein thrombosis(n:5) and thrombosis of inferior vena cava(n=2) were noted. CONCLUSION: Lymph node metastasis was seen in 67% in patients with peripheral cholangiocarcinoma. Direct invasion to adjacent organs and thrombosis in portal vein or inferior vena cava were occasionally associated.

Computed tomographic findings of cerebral paragonimiasis

Paragonimiasis is widely distributed in Far East and Southeast Asia, particularly in Korea. The centralnervous system is the most frequent location for paragonimiasis outside the lungs. We analized the computedtomographic findings of 17 cases which were diagnosed pathologically and clinically as cerebral paragonimiasis.The results were as follows; 1. The ratio of male to female was 10:7 and about 88% of cases were under the age of40 years. 2. The common location so cerebral paragonimiasis were the occipital (12 cases ) and temporal (11 cases) lobes. 3. Precontrast CT findings of cerebral paragonimiasis were low density with calcifications in 6 cases,low and isodensities in 4 cases, mixed densities in 3 cases, only low density in 2 cases and only calcification sin 2 cases. Hydrocephalus (7 cases), mass effect (6 cases), atrophic change(6 cases) and cyst formation (3 cases)were associated. 4. The shape of calcifications in CT scan were soap-bubble or ring in 6 cases, nodular or oval in6 cases, stippled in 4 cases and amorphous conglomerated in 2 cases. 5. The contrast-enhanced 8 cases were 5 ringor rim like, 2 nodular and 1 irregular enhancements, while 9 cases were not enhanced.

Ultrasonographic diagnosis of pancreatic and peripancreatic cancer

Seventeen cases of cancers in and adjacent to the pancreas were studied by high resolution and wide field realtime ultrasonographic scanner with 3.5MHz linear array electronically focusing transducer. The results were asfollows; 1. In a total of 17 cases, 7 cases were pancreatic cancers and the rests were 3 cases of ampulla of Vatercancers, 3 cases of distal CBD cancers, and 4 cases of metastatic cancers, respectively. 2. Pancreatic cancerswere located mainly in head portion, and metastatic cancers were noted in head, tail, and retropancreatic areas.3. The sized of all distal CBD cancer were less than 1.8cm, usually smaller than other tumors, and the size ofmetastatic cancers were variable (1-6cm). 4. The shape, margin, contour and echogenicity of the tumors werevariable. 5. Pancreatic duct showed marked dilatation in one of pancreatic cancer, and mild dilatation in one ofampullar of Vater cancer. 6. The caliber of extrahepatic duct were moderately or markedly dilated in nearly allcases except 2 cases of pancreatic body cancer. 7. The pancreatic margin is partially obliterated in pancreaticand ampulla of Vater cancers but not in distal CBD cancer. 8. Gallbladder enlargement is secondary change due tothe obstruction of extrahepatic bile duct. 9. Effects on the vessles are due to not only direct mass effect butdirect invasion resulting in obliteration. The most commonly involved vessels are spleno-portal junction, splenicvein and portal vein. In case of pancreatic cancer in uncinated process, the superior mesenteric vessels aredisplaced anteriorly. 10. Surrounding metastatic lesions were suspected in pancreatic and ampulla of Vater cancer,but not seen in distal CBD cancer. 11. Ascites were seen in only two cases of metastasis.

Middle cranial fossa tumors of rare and atypical CT features

Six different brain tumors in middle cranial fossa are presented which are studied by CT and proved pathologically. The authors experienced rare tumors in middle cranial fossa such as cavernous hemangioma, cysticmeningioma, Schwannoma, Masson's vegetant intravascular hemangioendothelioma and other tumors (arteriovenousmal formation and metastatic adenoid cystic carcinoma) whose CT findings were atypical. The results are as follows; 1. I case of tumors in middle cranial fossa, basal and coronal sections are necessary for further evaluation of the relation with dura and adjacent bone changes. 2. In suspicion of metastasis, bone setting should be done to find out bone involvement. 3. Internal carotid angiography gave little help in the differential diagnosis of tumors in middle cranial fossa.

Computed tomography of calcification of the basal ganglia

Calcification so of the basal ganglia are rarely found at routine autopsies and in skull radiographs. CT is superior to the plain skull radiographs in detecting intracranial attenuation differences and may be stated to bethe method of choice in the diagnosis of intracranial calcifications. Of 5985 brain CT scans performed in KyungHee Univeristy Hospital during past 3 years, 36 cases were found to have high attenuation lesions suggesting within basal ganglia. 1. The incidence of basal ganglia calcification on CT scan was about 0.6%. 2. Of these 36 cases, 34 cases were bilateral and the remainder was unilateral. 3. The plain skull films of 23 cases showed visible calcification of basal ganglia in 3 cases (13%). 4. No specific metabolic disease was noted in the cases.