Left Iliac Vein Compressions and Venous Hemodynamic Changes

PURPOSE: Left iliac vein compression is a risk factor for deep vein thrombosis (DVT) and often can be symptomatic. We wanted to know the incidence of left iliac vein compressions in the general population and the relationship between iliac vein compression and outflow fraction of the lower extremities. METHODS: 1,523 cases examined with abdomen - pelvis CT were included in this study. Left iliac vein compression was calculated as the diameter of left common iliac vein at the site of maximal compression divided by the diameter of the uncompressed caudal common iliac vein. These cases were divided into 4 groups by the degree of iliac vein compression. In addition, left lower extremity venous outflow fractions in 106 patients with abdomen - pelvis CT images were recorded and analyzed. RESULTS: The number and mean age of each group (group 1, 2, 3 and 4) were 351 (23%) & 62.3+/-13.4, 426 (28%) & 57.7+/-16.1, 529 (35%) & 50.1+/-20.4 and 217 (14%) & 40.7+/-22.9, respectively. While the age of patients was decreasing, the occurrence of left iliac vein compression increased (P<0.01). The mean left low extremity venous outflow fractions of each group (group 1, 2, 3 and 4) was 27.9+/-6.9%, 26.9+/-6.4%, 25.9+/-6.7% and 19.1+/-6.6%, respectively. The mean outflow fraction of group 4 was significantly lower than that of other groups (P<0.01). There was a tendency that the more left iliac vein compression increased, the more outflow fraction decreased (P=0.011). CONCLUSION: In 14% of 1,523 cases, there were severe left iliac vein compressions, more than 75% diameter, and the mean outflow fraction of that was lower than in others. Further study is needed to realize the relationship between left iliac vein compression and DVT.

Differentiation of Tuboovarian Abscess from Endometriosis: CT Indicators

PURPOSE: To assess and compare CT findings of surgically confirmed cases of tuboovarian abscesses (TOA) and endometriosis in order to identify indicators which may be helpful in making correct preoperative diagnoses. MATERIALS AND METHODS: Of the 35 consecutive patients with surgically confirmed TOA, CT images were available for 11 of those patients. As a comparative group, 36 patients with surgically confirmed endometriosis with CT images were selected. CT images of TOA were compared with those of endometriosis. A retrospective analysis of the CT images of both groups was performed without knowledge of the pathologic diagnosis. The analysis compared the thickness and enhancement pattern of the cyst wall, attenuation of the cyst content, size and shape of the cyst, and paraaortic lymphadenopathy. RESULTS: Mean thickness of the cyst wall was 6.2+/-2.0 mm in TOA and 4.5+/-2.4 mm in endometriosis. Multilayered appearance in both diseases was seen on enhanced CT in 91% (10/11) of TOA cases and in 25% (9/36) of endometriosis cases. Hounsefield units of the cyst contents were 20.0+/-5.5 HU and 24.7+/-10.0 HU for TOA and endometriosis, respectively. Mean diameter of the cysts was 7.5+/-1.7 cm in TOA and 7.9+/-3.1 in endometriosis. Shape of the cyst was multilocular in 82% (9/11) of TOA cases and in 75% (27/36) of endometriosis cases. Paraaortic lymphadenopathy was present in 73% (8/11) and 44% (16/36) for TOA and endometriosis, respectively. CONCLUSION: TOA should be suspected on CT when a multilocular cystic ovarian mass is observed, especially if the lesion has a thick wall and has a multilayered appearance, and is accompanied by paraaortic lymphadenopathy.

Central Lucency of Pelvic Phleboliths: Comparison of Plain Radiographs and Noncontrast Helical CT

PURPOSE: Central lucency of pelvic phleboliths is frequently observed on plain pelvic radiographs. When it is also present on noncontrast helical CT images, pelvic phleboliths may be easily diagnosed, with no suspicion of distal ureteral calculi. The objective of this study was to determine the frequency with which this phenome-non is seen on plain radiographs and noncontrast helical CT images. MATERIALS AND METHODS: During a recent two-year period we identified 70 patients with renal colic who under-went both abdomino-pelvic radiography and noncontrast helical CT scanning. Radiographs were obtained at 70 -85 kVp and 30 -40 mA; CT scans were preformed within one month of plain radiography with parameters of 120 kVp, 200 -220 mA, 5-mm collimation, and pitch of 1 -1.6, and using soft tissue and bone window settings. With regared to the central lucency of pelvic phleboliths, as seen on both on radiographs and CT im-ages, two experienced radiologists reached a consensus. RESULTS: Among the 70 patients, a total of 150 pelvic phleboliths was found. In all cases except one, pelvic radi-ography and noncontrast helical CT revealed the same number of phleboliths. The exception was a case in which one of two phleboliths demonstrated by CT was not seen on radiographs. Pelvic radiography revealed central lucency in 95 of these 150 phleboliths (63%), but noncontrast helical CT failed to depict a hypodense center in any phlebolith. CONCLUSION: Central lucency of pelvic phleboliths, as frequently seen on plain pelvic radiographs, was not revealed by routine noncontrast helical CT in any patient.The presence or absence of central lucency on these CT images cannot, therefore, be used to differentiate phleboliths from distal ureteral calculi.

CT and MR Findings of Presacral Epidermoid Cyst: A Case Report

Epidermoid cyst of the presacral space is a rare benign congenital lesion which is lined with keratinized squamous epithelium. We describe the computed tomography(CT) and magnetic resonance (MR) imaging findings in a case of presacral epidermoid cyst in a 35-year-old woman. The lesion appeared on CT as a well defined cystic mass with a thin wall. MR imaging showed heterogeneously low signal intensity on T1-weighted images and heterogeneously high signal intensity on T2-weighted images.

Periurethral Granular Cell Tumor: A Case Report

Granular cell tumors are uncommon soft tissue tumors which arise as solitary or multiple masses. Lesionscommonly arise in the head, neck, and chest wall, but can occur in any part of the body. To our knowledge,periurethral granular cell tumor has not been previously reported. We report one such case.

Gadolinium-enhanced Fat-Suppression MR Imaging of the Female Pelvis

PURPOSE: To compare the value of Gd-DTPA enhanced, fat-suppression T1-weighted (Gd-FST1SE) MR images in thediagnosis of female pelvic disorders with that of fast spin-echo T1-weighted(T1FSE) and fast spin-echoT2-weighted(T2FSE) MR images. MATERIALS AND METHODS: Pelvic MR images of 42 women (24 ovarian disorders, 19uterine disorders) were reviewed by two radiologists. Discrimination of normal anatomic structures, identificationof pathologic lesions and recognition of internal structure of the lesions such as solid and cystic portion,papillary nodule, septa and wall were evaluated using a scoring system. The Friedman two-way ANOVA test was usedfor data analysis. RESULT: T2FSE was useful for evaluation of the uterine cervix(T1/T2/Gd, 2.5/3.9/2.8,respectively), junctional zone(1.6/3.1/2.5), endometrium (2.0/3.3/3.0), ovary(1.1/2.1/1.7) and uterine myoma(1.7/2.4/2.1)(P<0.001), but secondary degeneration was best visualized on Gd-FS T1SE. The Gd-FS T1SE ;lymphadenopathy(3.4/1.5/3.7) was better visualised on this modality than on eithor TIFSE or T2FSE. Gd-FS T1SEimages also clearly depicted papillary projection(2.4/3.1/3.8) and the solid component (2.9/3.1/3.5) of ovariancystic neoplasm(P<0.01). The confidence level in the identification of ovarian mass, internal septation andsurrounding wall of cystic neoplasm was not improved on Gd-FS T1SE. CONCLUSION: The Gd-FS T1SE images were usefulfor the evaluation of metastatic lymphadenopathy in uterine cervical malignancy and for identification of thesolid component and papillary projection of ovarian cystic neoplasm.

Isolated Torsion of Fallopian Tubes: Detection of Pedicle at Tubal End: Two Case Report

Adnexal and ovarian torsion cause acute or chronic abdominal pain, and on ultrasonography, CT and MRI, theradiologic findings of twisted pedicle are clearly demonstrated. Due not only to the rarity of the disease butalso because the symptoms and signs are similar to those seen in cases of adnexal torsion, isolated torsion of thefallopian tubes is not easily diagnosed. The author describes two cases of this condition which on CT andultrasonography showed the "whirling" pattern of twisted pedicle located at the tubal end ; this pattern isassociated with tubal pregnancy or hydrosalpinx. The distal location of twisted pedicle at the fallopian tube,ipsilateral tubal dilatation and ipsilateral normal ovary suggests isolated torsion of the fallopian tubes.

Aggressive Angiomyxoma in Female Pelvic Cavity: A Case Report

Aggressive angiomyxoma is a rare neoplasm occurring in the female pelvic cavity or perineum, and tends torecur. The radiographic findings of angiomyxoma have not been previously reported in Korea ; we describe a case ofaggressive angiomyxoma in the female pelvic cavity, with emphasis on the pathologic and radiologic findings, andreview the literature.