Subject(s)
Cerebral Angiography , Ischemic Attack, Transient/diagnosis , Magnetic Resonance Angiography , Porphyrias/diagnosis , Adult , Cerebral Infarction/diagnosis , Cerebral Infarction/drug therapy , Cerebral Infarction/genetics , Diagnosis, Differential , Female , Hemin/therapeutic use , Humans , Ischemic Attack, Transient/drug therapy , Ischemic Attack, Transient/genetics , Porphyrias/drug therapy , Porphyrias/geneticsABSTRACT
We describe the CT and MR findings in a patient diagnosed with tuberous sclerosis after presenting with a hemorrhagic subependymal giant cell astrocytoma (SEGCA). While these tumors are not uncommon in tuberous sclerosis, hemorrhage into them is extremely rare.
Subject(s)
Brain Neoplasms/complications , Cerebral Hemorrhage/etiology , Glioma/complications , Tuberous Sclerosis/complications , Adolescent , Brain Neoplasms/diagnostic imaging , Cerebral Hemorrhage/diagnostic imaging , Female , Glioma/diagnostic imaging , Humans , Radiography , Tuberous Sclerosis/diagnostic imagingABSTRACT
The anatomy of the cranial dura and leptomeninges is both intricate and complex. A thorough discussion of the protective covering of the brain including the dura, arachnoid, and pia is provided on both gross and microscopic levels. An attempt to include issues of clinical relevance is made, highlighting the Virchow-Robin spaces and the optic sheath. In addition, the normal appearance of the dura and leptomeninges on MRI is presented to establish a framework for the discussion of leptomeningeal pathology.
Subject(s)
Meninges/anatomy & histology , Arachnoid/anatomy & histology , Arachnoid/embryology , Arachnoid/metabolism , Central Nervous System Diseases/pathology , Cerebrospinal Fluid/metabolism , Dura Mater/anatomy & histology , Dura Mater/blood supply , Humans , Magnetic Resonance Imaging , Meninges/blood supply , Pia Mater/anatomy & histologyABSTRACT
One hundred forty-three patients with bronchogenic carcinoma were studied prospectively with computed tomography (CT) to determine the accuracy of CT in the evaluation of mediastinal nodal metastases. Mediastinal lymph nodes were localized according to the lymph node mapping scheme of the American Thoracic Society and were considered abnormal if they exceeded 1 cm in short-axis diameter. All patients underwent surgical staging, which consisted of either mediastinoscopy alone or mediastinoscopy and thoracotomy. At the time of surgical staging, all accessible nodes were either removed or sampled. The sensitivity of CT for mediastinal nodes on a per-patient basis was 64%, with a specificity of 62%. The sensitivity of CT for individual nodal stations involved with tumor was only 44%. The presence of obstructive pneumonitis did not appreciably alter the sensitivity of CT, but the specificity was lower (43%). The likelihood of metastases increased with lymph node size; however, seven of 19 (37%) lymph nodes that measured 2-4 cm in short-axis diameter were hyperplastic and did not contain metastases. The relative insensitivity of CT makes formal nodal sampling at the time of mediastinoscopy or thoracotomy essential to detect lymph node metastases.
Subject(s)
Carcinoma, Bronchogenic/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Lymph Nodes/diagnostic imaging , Neoplasm Staging , Tomography, X-Ray Computed , Adult , Aged , Biopsy , Carcinoma, Bronchogenic/pathology , False Negative Reactions , False Positive Reactions , Female , Humans , Lung Neoplasms/pathology , Lymph Nodes/pathology , Lymphatic Metastasis , Male , Mediastinoscopy , Mediastinum/diagnostic imaging , Middle Aged , Prospective Studies , Sensitivity and SpecificityABSTRACT
A scoring system was devised for the assessment of coronary artery calcifications apparent on computed tomographic (CT) scans, with width and length used to assess severity. The degree of calcification was compared with the presence of stenoses of 70% or greater at cardiac catheterization in 46 patients who underwent both studies. Although many significantly stenosed vessels showed no calcification, heavy calcifications had a high positive predictive value for significant disease. In a separate branch of the study, the perioperative cardiac morbidity and mortality were compared in 30 age- and sex-matched pairs of patients undergoing thoracotomy who did and did not have coronary calcifications on CT scans obtained before surgery. Patients with calcifications had a higher frequency of cardiac complications, including arrhythmias, ischemia, hypotension, myocardial infarction, and death.
