Cavernous Hemangioma of the Adrenal Gland: A Case Report

Hemangiomas are rare benign tumors of the adrenal gland. We report here on the CT findings of a cavernous hemangioma of the right adrenal gland. The CT revealed a well-delineated adrenal mass having an internal necrotic portion and tiny peripheral calcifications. After administration of the contrast media, the tumor showed peripheral enhancement on the arterial phase, and this was followed by progressive centripetal fill-in.

Thoracic and Abdominal CT Findings of Hypovolemic Shock Patients with Cardiac Arrest During CT Examination

PURPOSE: The purpose of this study is to describe the abdominal and the thoracic CT findings of cardiac arrest that occurs during CT examination. METHODS: We retrospectively reviewed CT findings of seven patients who had cardiac arrest during CT examination. A contrast-enhanced abdominal CT was performed in all patients, and a thoracic CT was performed in three of them. RESULTS: The injected contrast agent was mostly distributed in the venous system, forming a blood-contrast level in the superior or inferior vena cava in all patients. One of the most striking findings was regurgitation of the contrast medium via the inferior vena cava into the right hepatic and renal veins. The right hepatic vein and the dependent portion of the right hepatic parenchyma were strongly enhanced in all patients, and the portal vein was enhanced in four. Retrograde opacification of the right renal vein was seen in six patients, the right renal parenchyma and the right gonadal vein were opacified in four of those six patients. The abdominal aorta showed a small caliber in all patients, and it was faintly enhanced in one patient. Except for one patient, the left cardiac chambers were not opacified. Retrograde pooling of contrast agent via the right atrium into the coronary sinus was seen in five patient, and the great cardiac vein was also opacified in three of those five patients. CONCLUSION: The CT features of cardiac arrest are characterized by the forming of a blood-contrast level in the vena cava and retrograde strong contrast enhancement of the abdominal veins and the dependent portion of the right hepatic and renal parenchyma.

A Functional MRI Study on the Brain Activation Associated with Mental Calculation

PURPOSE: In order to investigate the functional brain anatomy associated with mental calculation, functional magnetic resonance imaging was performed. MATERIALS AND METHODS: In six normal right handed subjects, functional MR images were obtained using a 1.5T MR scanner and the EPI BOLD technique. The study included experiment I and experiment II. Each experiment consisted of five resting and four activation periods with each period of 30 seconds. During the activation period of both experiment I and II, calculation equations[an example: (4+5)x 8=72] were presented and the subjects were instructed to decide true or false of them. During the resting period of experiment I, the subjects were instructed to visually fixate on a crosshair. During the resting period of experiment II, two diagrams(an example: circle, square) were presented and the subjects were instructed to decide they are same or not. For the post-processing of images, the SPM program was used, with the threshold of significance set at p<0.00001. The activated areas during the tasks were assessed. RESULTS: In experiment I, the inferior frontal gyrus, prefrontal cortex, premotor area, supplementary motor area, and intraparietal sulcus including superior parietal cortex were activated bilaterally. Although these areas were also activated in experiment II, the activated signals in the right frontal and parietal lobes were lessened. CONCLUSION: The left inferior frontal gyrus and prefrontal cortex and bilateral intraparietal sulci were activated during mental calculation. The right frontal and parietal lobes might be related to attention and decision making.

A Functional MRI Study on the Brain Activation Associated with Mental Calculation

PURPOSE: In order to investigate the functional brain anatomy associated with mental calculation, functional magnetic resonance imaging was performed. MATERIALS AND METHODS: In six normal right handed subjects, functional MR images were obtained using a 1.5T MR scanner and the EPI BOLD technique. The study included experiment I and experiment II. Each experiment consisted of five resting and four activation periods with each period of 30 seconds. During the activation period of both experiment I and II, calculation equations[an example: (4+5)x 8=72] were presented and the subjects were instructed to decide true or false of them. During the resting period of experiment I, the subjects were instructed to visually fixate on a crosshair. During the resting period of experiment II, two diagrams(an example: circle, square) were presented and the subjects were instructed to decide they are same or not. For the post-processing of images, the SPM program was used, with the threshold of significance set at p<0.00001. The activated areas during the tasks were assessed. RESULTS: In experiment I, the inferior frontal gyrus, prefrontal cortex, premotor area, supplementary motor area, and intraparietal sulcus including superior parietal cortex were activated bilaterally. Although these areas were also activated in experiment II, the activated signals in the right frontal and parietal lobes were lessened. CONCLUSION: The left inferior frontal gyrus and prefrontal cortex and bilateral intraparietal sulci were activated during mental calculation. The right frontal and parietal lobes might be related to attention and decision making.

Odontogenic Versus Nonodontogenic Deep Neck Space Infections: CT Manifestations

PURPOSE: The purpose of this study was to evaluate computed tomographic (CT) findings of deep neck space infection(DNSI) with particular attention to the differences in the spaces involved and in complications between odontogenic and nonodontogenic groups. MATERIALS AND METHODS: Forty-four patients(21 odontogenic and 23 nonodontogenic) were included in this study. Among odontogenic DNSls, 15 had the dental infection in the second or third mandibular molar. We compared the CT features between odontogenic and nonodontogenic DNSIs with special emphasis on the differences in the spaces involved and in the rate and type of complications. RESULTS: In all patients, CT clearly differentiated abscess from cellulitis. The most common spaces involved in 21 patients with odontogenic DNSl were the parapharyngeal(n=18), the submandibular(n=18), the anterior visceral(n=13), the masticator(n=9), and the sublingual(n=7) spaces. In contrast, in 23 patients with nonodontogenic DNSI, the anterior visceral space(n=14) was most frequently involved. The parapharyngeal, the submandibular, and the masticator spaces were statistically more frequently involved in odontogenic than in nonodontogenic DNSI(p<.05). Twenty-two patients had one or more complications shown by CT, of which airway compromise was more frequent and severe in odontogenicthan in nonodontogenic DNSI. CONCLUSION: We conclude that the parapharyngeal, the submandibular, and the masticator spaces are more significantly vulnerable in odontogenic DNSl than in nonodontogenic DNSl. The predilection for certain spaces of the neck in odontogenic DNSl seems to originate from the intimate relationship of the mandibular molars to the adjacent deep neck spaces.

Odontogenic Versus Nonodontogenic Deep Neck Space Infections: CT Manifestations

PURPOSE: The purpose of this study was to evaluate computed tomographic (CT) findings of deep neck space infection(DNSI) with particular attention to the differences in the spaces involved and in complications between odontogenic and nonodontogenic groups. MATERIALS AND METHODS: Forty-four patients(21 odontogenic and 23 nonodontogenic) were included in this study. Among odontogenic DNSls, 15 had the dental infection in the second or third mandibular molar. We compared the CT features between odontogenic and nonodontogenic DNSIs with special emphasis on the differences in the spaces involved and in the rate and type of complications. RESULTS: In all patients, CT clearly differentiated abscess from cellulitis. The most common spaces involved in 21 patients with odontogenic DNSl were the parapharyngeal(n=18), the submandibular(n=18), the anterior visceral(n=13), the masticator(n=9), and the sublingual(n=7) spaces. In contrast, in 23 patients with nonodontogenic DNSI, the anterior visceral space(n=14) was most frequently involved. The parapharyngeal, the submandibular, and the masticator spaces were statistically more frequently involved in odontogenic than in nonodontogenic DNSI(p<.05). Twenty-two patients had one or more complications shown by CT, of which airway compromise was more frequent and severe in odontogenicthan in nonodontogenic DNSI. CONCLUSION: We conclude that the parapharyngeal, the submandibular, and the masticator spaces are more significantly vulnerable in odontogenic DNSl than in nonodontogenic DNSl. The predilection for certain spaces of the neck in odontogenic DNSl seems to originate from the intimate relationship of the mandibular molars to the adjacent deep neck spaces.

Prevalence of Paranasal Sinus Opacification in Infants and Children without Overt Sinusitis using Computed Tomography

PURPOSE: To evaluate the prevalence of the opacification of paranasal sinuses and to correlate the prevalence and severity of the sinus opacification with presence of upper respiratory infection (URI) in infants and children using CT. MATERIALS & METHODS: We analyzed CT scans of 162 children aged under 16 who have no signs and symptoms of paranasal sinusitis. Both sides of maxillary and ethmoidal sinuses were evaluated. We scored from 0 to 3 according to the degree of soft tissue opacification of each sinus and then summed up the scores of each sinus. We divided the children into 5 groups according to their age. We paid particular attention to the following respects: 1) the prevalence of the opacification of the paranasal sinuses in each group; 2) the difference in the prevalence between the children with and without URI ;3) the correlation between the severity of the sinus opacification and the presence of URI. RESULTS: Of 162 children, one or more paranasal sinus opacification was noted in 76(47 %):31(65%) less than 1 year old;11(52%) between 1 and 2 years old;16(53%) between 2 and 6 years old ;15(28%) between 6 and 12 years old;and 3(33%) above 12 years old. In children less than 1 year old, no significant difference in the prevalence of the sinus opacification was found between URI-positive(71%) and URI-negative(58%) subgroups. In chilren between 1 and 12 years old, although the prevalence of the sinus opacification in URI-positive subgroups was much greater than that in URI-negative subgroup, statistically significant difference was noted only in children between 2 and 6 years old. As to the correlation between the severity of the sinus opacification and the presence of URI, these was a statistically significant difference in children between 2 and 6 years old and between 6 and 12 years old. CONCLUSION: Although the exact pathophysiology is not fully understood, the opacification of the paranasal sinuses is not an uncommon finding at CT in children without the signs and symptoms of sinusitis. We think that the clinical correlation is essential in determining the diagnosis and treatment plan in cases that the sinus radiographs or CT scans show the abnormal findings.

MR Imaging Findings of Spinal Subarachnoid Hemorrhage: A Case Report

We report magnetic resonance imaging findings of massive spinal subarachnoid hemorrhage (SAH) caused by repeated lumbar punctures during spinal anesthesia in a 36-year-old man. The signal intensities of spinal SAH were similar to those of the conus medullaris on both T1 and T2- weighted spin-echo images. Although spinal SAH is hardly recognized on MR, spinal SAH of sufficient amount may cause alteration of the cerebrospinal fluid signal.

Normal development of the paranasal sinuses in children: a CT study

To evaluate the normal development of the paranasal sinuses in children with CT, authors prospectively studied with brain CT scans of 260 children without known sinus diseases, ranging in age from 7 days to 16 years. Maximal anteroposterior and transverse diameters(mm) and maximal cross-sectional area(mm2) of both sides of the maxillary sinus were measured with the aid of computer device. As to the ethmoidal and sphenoidal sinuses, we simply documented the presence of the aplastic ethmoidal sinus and calculated the age-incidence of the sphenoidal sinus pneumatization, respectively. There noted three phases in the development of the maxillary sinus. The anteroposterior and transverse diameters of the maxillay sinus increased nearly in parallel. The former was always greater than the latter. In no cases was the ethmoidal sinus aplastic and almost all sinuses were pneumatized even in infants as early as 7 days old. CT identified the conchal pattern of sphenoidal sinus pneumatization in infants as early as 11 days old. Sphenoidal sinus pueumatization was seen in 38% of the children under the age of 1 year, 82% of the children between the age of 1 and 2 years, and almost all children older than 2 years. The anteroposterior and transverse diameters of the maxillary sinus seem to reach the adult size by 8 years of age, and the conchal pattern of sphenoidal sinus pneumatization can be recognized earlier with CT than on the plain radiographs.

Cerebral infarction secondary to temporal lobe herniation in head trauma: a CT study

Cerebral infarction is a known complication of temporal lobe herniation caused by a traumatic intracranial lesion. To ascertain the frequency, time of recognition, and influence on mortality of posttraumatioc cerebral infarction secondary to temporal lobe herniation, we retrospectively reviewed brain CT scans and clinical records of 55 patients who had CT and clinical signs of temporal lobe herniation on admission date. Cerbral infarctions were recognized in seven (12.7%) patients on CT scans taken within two days after admission (mean: 1.3 days). Cerbral infarctions were in the terrtiories of the posterior cerbral artery in all seven patients, two of whom had infarctions of the anterior choroidal artery as well. Mortality (71.4%) for these seven patients was not statistically significant from that (50%) of patients without cerebral infarction admitted with the same range of Glasgow Coma Scale score. The result suggests that such cerebral infarction does not greatly influence atient's mortality.