Bronchus sign on CT in peripheral carcinoma of the lung: value in predicting results of transbronchial biopsy.

The bronchus sign on CT represents the presence of a bronchus leading directly to a peripheral pulmonary lesion. We investigated the value of this sign in predicting the results of transbronchial biopsy and brushing in 33 consecutive cases of proved peripheral bronchogenic carcinoma studied with thin-slice CT (2-mm-thick sections). The bronchus sign was seen on CT in 22 patients and was absent in 11. Transbronchial biopsy and brushing showed peripheral carcinoma in 13 (59%) of 22 patients in whom the bronchus sign was seen on CT and in only two (18%) of 11 patients in whom it was not seen. The difference is statistically significant (Fisher's exact test, p = .029). When analyzed by the order of involved bronchus, a 90% success rate of transbronchial biopsy and brushing was found in patients in whom the bronchus sign was seen at a fourth-order bronchus (p = .01). This compared with a success of 33% when the bronchus sign was seen at fifth-, sixth-, or seventh-order branches. Our results suggest that the bronchus sign at a fourth-order bronchus is valuable in predicting the success of transbronchial biopsy and brushing. The presence of the sign on CT may be useful in determining if the workup should include transbronchial biopsy and brushing or transthoracic needle aspiration in patients with peripheral lung lesions.

[Trans-sphenoidal spread of rhinopharyngeal neoplasms. Correlations between computerized tomography and magnetic resonance]. / La diffusione permeativa trans-sfenoidale delle neoplasie della rinofaringe. Correlazione TC ed RM.

In 1957 Teoh observed, in an autopsic series of 31 patients with nasopharyngeal carcinoma, 3 cases of neoplastic spread through the marrow spaces of the base of the skull, without macroscopic bone alterations. In order to demonstrate in vivo this kind of neoplastic spread, CT and MR examinations of 35 patients with nasopharyngeal carcinoma were reviewed. In 3/26 cases the invasion of the marrow spaces of the clivus was demonstrated. In these cases CT showed only minimal alterations in spongiosa and cortices of the clivus, associated with intracranial soft-tissue tumoral components. MR imaging demonstrated, with great accuracy, the replacement of bone marrow in the clivus by neoplastic tissue of intermediate signal intensity on T1-weighted images. Tumor tissue was characterized by high signal intensity on T2-weighted images. The authors stress the greater utility of MR imaging in evaluating the permeative involvement of the base of the skull.

[Extra-abdominal spread of pelvic neoplasms. CT evaluation and radiotherapeutic implications]. / Diffusione extra-addominale delle neoplasie pelviche. Valutazione TC ed implicazioni radioterapiche.

Meyers and other authors have described the extra-abdominal spread of inflammatory abdominal diseases. Conversely, little attention has been paid to the extra-abdominal spread of pelvic neoplasms. The authors have detected, by means of CT, 17 cases of extra-abdominal neoplastic spread in a series of 203 patients with pelvic neoplasms. Neoplastic spread involved the inguinal region in 1 case, the buttock in 6 cases, and the ischiorectal fossa and/or perineum in 12 cases, with more than one region involved in some patients. In such cases CT showed the extension of tumoral tissue beyond the muscular walls of the pelvis. Recurrent pelvic carcinomas are the most common neoplasms spreading outside the pelvis. Surgical obliteration of the pelvic fasciae can explain such a behavior. Differential diagnosis is to be made with inflammatory pelvic diseases with extrapelvic spread. When a pelvic tumor spreads outside the pelvis it can be seen as a primitive gluteal or inguinal or perineal mass. CT demonstration of such an insidious event is mandatory for both a correct diagnosis and radiation treatment planning.