ABSTRACT
A 43-year-old man with the acquired immunodeficiency syndrome had clinical evidence of multifocal disease of the brain, but computed tomography was negative. Magnetic resonance imaging revealed multifocal lesions, histologically proven to be caused by cytomegalovirus. Therapy with 9[2-hydroxy-1-(hydroxymethyl) ethoxymethyl] guanine (BW B759U) resulted in stabilization of the patient's clinical disease and radiographic improvement of the lesions.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Cytomegalovirus Infections , Encephalitis/etiology , Acyclovir/analogs & derivatives , Acyclovir/therapeutic use , Adult , Cytomegalovirus Infections/complications , Cytomegalovirus Infections/microbiology , Encephalitis/complications , Encephalitis/drug therapy , Encephalitis/pathology , Ganciclovir , Humans , Magnetic Resonance Imaging , MaleABSTRACT
External hydrocephalus (EH) is a condition in which infants with rapidly enlarging heads are found to have a CT scan that shows widening of the subarachnoid space with mild or no ventricular dilation. In this study, 74 infants with EH associated with a variety of conditions were examined clinically and with CT scans to identify the radiologic features of the condition as well as to understand its clinical and radiologic evolution. Some of these CT scans were compared with those of patients with cerebral atrophy. The characteristic CT findings in EH were bifrontal widening of the subarachnoid space and widened interhemispheric fissure frontally with only mild enlargement of the rest of the subarachnoid space. Occasional mild to moderate ventriculomegaly was also present. In most cases the radiologic findings could be distinguished from those seen in cerebral atrophy, even without the clinical history of an enlarging head. The cases of cerebral atrophy showed prominent sulci throughout without disproportionate bifrontal widening of the subarachnoid space. Two major groups of infants are identified. The largest group (47) consisted of infants with primary megaloencephaly. Megaloencephaly was idiopathic in 40 infants, many of whom (19) met the criteria for benign familial macrocephaly. Others (7) had a clearly defined genetic syndrome. The radiologic abnormalities in these infants usually disappear by 2 years of age. The other major group (14) consisted of infants who sustained CNS or systemic insults such as subdural hematomas (8) or meningitis (3), which cause impaired CSF absorption. Thirteen premature infants with EH were also identified. It is concluded that EH is an age-related self-limited condition occurring in infants with open cranial sutures and that usually resolves without intervention by 2-3 years of age.
Subject(s)
Brain/diagnostic imaging , Hydrocephalus/diagnostic imaging , Infant, Premature, Diseases/diagnostic imaging , Tomography, X-Ray Computed , Atrophy/diagnostic imaging , Brain/pathology , Cephalometry , Cerebral Ventriculography , Child, Preschool , Cranial Sutures/pathology , Diagnosis, Differential , Female , Humans , Hydrocephalus/pathology , Infant , Infant, Newborn , Male , Subarachnoid Space/diagnostic imagingABSTRACT
Computed tomographic (CT) guided biopsy and abscess drainage of multiple organ systems have been well described. Reports of spinal and skeletal applications have been less common. This study describes the use of CT guidance in the biopsy of various skeletal lesions in 46 patients. Forty-one patients had skinny needle aspirations (18 or 22 gauge) and 23 patients had trephine core biopsies. Sites of the lesions included: thoracic spine-15 patients, lumbosacral spine-17 patients, bony pelvis-6 patients, rib-2 patients, and long bones-6 patients. Fast scanners capable of rapid image reconstruction have overcome many constraints. With CT guidance, the physician who performs the procedure receives virtually no ionizing radiation. The exact location of the needle tip is accurately visualized in relation to the lesion being biopsied and to the vital organs.
Subject(s)
Biopsy, Needle/methods , Bone Diseases/pathology , Tomography, X-Ray Computed , Bone Diseases/diagnostic imaging , Evaluation Studies as Topic , Humans , Spinal Diseases/diagnostic imaging , Spinal Diseases/pathologyABSTRACT
Iohexol and iopamidol, two new nonionic contrast media, have been extensively studied in comparison with metrizamide for lumbar myelography. Review of the literature with statistical analysis indicates both agents are superior to metrizamide in terms of number of patients with adverse reactions (p less than 0.001). Preliminary data suggest, but do not prove, that use of iohexol may result in fewer side effects than iopamidol.
Subject(s)
Iohexol/adverse effects , Iopamidol/adverse effects , Metrizamide/adverse effects , Humans , Myelography , Prospective Studies , Random AllocationABSTRACT
Retrospective review of 1517 lumbar CT examinations revealed extraspinal pathology in 22 (1.45%). Retroperitoneal tumors and lymphadenopathy as well as vascular, urinary tract and gynecologic abnormalities were identified. This study demonstrates the need to carefully evaluate the visualized portions of the abdomen and pelvis on all lumbar spine CT examinations even when the patient's symptomatology is suggestive of spinal abnormalities.
Subject(s)
Aortic Aneurysm/diagnostic imaging , Genital Diseases, Female/diagnostic imaging , Kidney Diseases/diagnostic imaging , Lumbar Vertebrae/diagnostic imaging , Pelvic Neoplasms/diagnostic imaging , Retroperitoneal Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Adult , Aged , Diagnostic Errors , Female , Humans , Male , Middle Aged , Retrospective StudiesSubject(s)
Acquired Immunodeficiency Syndrome/complications , Brain Diseases/diagnostic imaging , Tomography, X-Ray Computed , Acquired Immunodeficiency Syndrome/diagnostic imaging , Brain Diseases/etiology , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/etiology , Cryptococcosis/diagnostic imaging , Cytomegalovirus Infections/diagnostic imaging , Encephalitis/diagnostic imaging , Encephalitis/etiology , Humans , Leukoencephalopathy, Progressive Multifocal/diagnostic imaging , Leukoencephalopathy, Progressive Multifocal/etiology , Lymphoma/diagnostic imaging , Lymphoma/etiology , Meningeal Neoplasms/diagnostic imaging , Meningeal Neoplasms/etiology , Meningitis/diagnostic imaging , Meningitis/etiology , Toxoplasmosis/diagnostic imagingABSTRACT
Tc-99m IDA cholescintigraphy frequently provides information regarding nonbiliary pathology, such as small bowel obstruction. The cholescintigraphic finding of functional cystic duct obstruction concomitant with persistent small bowel dilatation and lack of progression of labeled bile suggests the diagnosis of gallstone ileus.