Massive cavitation of solid pulmonary metastatic lesions in a breast cancer patient: a case report.

A 40-year-old female with metastatic breast cancer developed multiple lung nodules some of them with cavitations. Following treatment with Taxol/Herceptin most of the lesions disappeared and in many cavity lesions appeared. There was no further change in the appearance of lung lesions.

Congenital insensitivity to pain with anhidrosis (CIPA): the spectrum of radiological findings.

BACKGROUND: Congenital insensitivity to pain with anhidrosis (CIPA) is an exceedingly rare, hereditary, sensory autonomic neuropathy (HSAN). AIM: To evaluate the various skeletal manifestations and cranial CT features in children affected by CIPA. MATERIALS AND METHODS: In the semidesert area of the Negev, the Bedouin tribes constitute a closed society where consanguineous marriages are the custom. This has resulted in a group of 20 children being affected by this rare autosomal recessive HSAN. The skeletal surveys and CT scans of these 20 Bedouin patients, 12 girls and 8 boys, ages ranging between 1 month and 8 years, were retrospectively analysed. Cranial CT scans were performed in ten children because of neonatal hypotonia and psychomotor retardation. The skeletal findings were classified as follows: fractures, joint deformities, joint dislocations, osteomyelitis, avascular necrosis and acro-osteolysis. RESULTS: All 20 patients had fractures of the extremities and acro-osteolysis of the fingers. Six had joint deformities. Three children had recurrent hip joint dislocations and another three had avascular necrosis. Ten patients presented with osteomyelitis of the limbs, acetabulum and scapula. The cranial CT scans disclosed mild brain volume loss with some ventriculomegaly. CONCLUSIONS: CIPA is a severe autosomal recessive condition that leads to self-mutilation early in life and to fractures, osteomyelitis and limb amputation in older children. Mental retardation is common. Death from hyperpyrexia occurs in almost 20 % of patients in the first 3 years of life.

Hip flexion and lumbar puncture: a radiological study.

When lumbar puncture is performed in the sitting position, the patient's thighs are usually at an angle of approximately 90 degrees to the trunk, whereas in the lateral position, hip flexion is employed by flexing the patient's knees to the chest. We measured the presumed but hitherto unquantified widening of lumbar interspinous spaces resulting from hip flexion. Lumbar spine lateral radiographs were taken in volunteers in the sitting position with and without hip flexion, and interspinous space width was measured and compared. Mean lumbar interspinous space width at L2-3, L3-4 and L4-5 increased by 7%, 11% and 21%, respectively, with the hips flexed. Hip flexion in the sitting position will anatomically optimise lumbar interspinous space width for needle passage, and statistically significant increases in space width have been demonstrated increasing progressively from L2-3 to L4-5.

Bilateral idiopathic chondrolysis of the hip: a case report.

A case of bilateral idiopathic chondrolysis of the hip is presented. Chondrolysis is a process characterized by progressive necrosis of the hyaline cartilage of the acetabulum and femoral head, resulting in secondary joint space narrowing and stiffness. A 14-year-old boy was followed during a 2-year period, and the diagnostic values of the different imaging methods (radiography, magnetic resonance imaging [MRI], and bone scintigraphy) were evaluated. Scintigraphic evidence of marked periarticular uptake and premature fusion of the epiphysis of the greater trochanter was a reliable indicator of chondrolysis. Furthermore, the bone scan could precede other imaging methods (radiography and MRI) in the diagnosis of the progression of the pathologic process, status of the remodeling activity, and early involvement of an opposite joint. Given the high sensitivity of bone scans and the high specificity of radiographic and MRI examinations in the diagnosis of acute chondrolysis of the hip, all three methods are valuable and should be used as complementary diagnostic tools.

Congenital unilateral hydrocephalus--CT findings.

Congenital unilateral hydrocephalus is extremely uncommon with 18 cases previously reported in the English literature. Two additional newborns with unilateral hydrocephalus are presented. The second baby also presented a mega cisterna magna. This unusual association between Dandy-Walker variant and unilateral hydrocephalus has not been previously reported. Following ventriculo-peritoneal shunt, the babies had a normal cognitive neurodevelopment. The role of cranial computed tomography (CT) in diagnosis and follow-up is emphasized.

Unilateral acute renal cortical necrosis: correlative imaging.

Bilateral acute cortical necrosis is a rare form of acute renal failure characterized by necrosis of the renal cortex and sparing of the medulla. Little information on the imaging presentation of bilateral acute renal cortical necrosis is available. The enhanced CT appearance is pathognomonic and diagnostic. The unilateral presentation of acute cortical necrosis is extremely rare, and no imaging methods have been described. The authors chose to apply scintigraphic evaluation to this unique condition complementary to CT to confirm the diagnosis. Mercaptoacetylglycine (T3) was selected to assess tubular damage, in contrast to the pure glomerular agent DTPA. Evidence of some tubular function and clear delineation of the shrunken kidney was found. Conversely, in the DTPA study the kidney was not visualized. A DMSA scan was performed for assessment of viability of the renal cortex and showed a photopenic halo around the small area of the viable cortex of the upper pole. The halo sign represents a cortical loss. The visualization of the upper pole as evidence of cortical viability as a consequence of collateral blood flow from capsular vessels was seen on angiography. Radiographic and scintigraphic correlation of this rare condition may be an effective means to confirm the diagnosis and to establish the extent of involvement. However, contrast CT remains the preferred method in the diagnosis of acute cortical necrosis.

Post-traumatic recto-spinal fistula.

Acquired recto-spinal fistula has been described elsewhere as a rare complication of colorectal malignancy and Crohn's enterocolitis. We treated a young man who developed a recto-spinal fistula as a result of a high fall injury. The patient presented with meningeal signs, sepsis and perianal laceration. Computerized axial tomography revealed air in the supersellar cistern. Gastrografin enema showed that contrast material was leaking from the rectum into the spinal canal. Surgical management included a diverting sigmoid colostomy, sacral bone curettage and wide presacral drainage. To the best of our knowledge, rectospinal fistula of traumatic origin has not been previously reported in the English literature.

Renal transplant dysfunction due to severe aorto-iliac atherosclerosis in the presence of patent renal transplant artery.

We report a case of progressive deterioration in renal function and decreased renal graft perfusion induced by extensive aorto-iliac atherosclerotic lesions proximal to a patent renal graft artery. Significant improvement in kidney graft function followed left axillo-femoral bypass graft surgery, which to the best of our knowledge, has never been performed previously for permanent maintenance of renal transplant perfusion.

Cerebral sinovenous thrombosis in the idiopathic hypereosinophilic syndrome in childhood.

The idiopathic hypereosinophilic syndrome (HES) is a leukoproliferative disorder marked by a sustained overproduction of eosinophils and a distinct predilection to damage specific organs, especially the cardiovascular system. It is primarily a disease of middle-aged people. Occasional cases have been encountered in children. We report a case of an 11-year-old boy affected by idiopathic HES with an unusual rapidly fatal course. In addition to eosinophilic cellulitis, cerebral straight and superior sagittal sinus vein thrombosis (CVT) was evident on cranial CT. In our review of the English literature we were unable to find an association between idiopathic HES and CVT.

Intrathoracic rib demonstrated by helical CT with three-dimensional reconstruction.

Intrathoracic rib is a rare congenital anomaly. An unusual location with atypical pleural tenting is reported. Helical CT with three-dimensional reconstruction seems the best modality for demonstrating the origin and location of these abnormal ribs. The importance of the diagnosis of intrathoracic rib is to rule out pulmonary lesions and prevent unnecessary investigations.

Chronic intussusception in childhood.

A rare case of chronic intussusception is reported. Radiological investigation including ultrasound, CT and barium enema provided the correct diagnosis. Ultrasound revealed a solid mass near the transverse colon in the right lower abdomen. CT demonstrated the real nature of the solid mass as being the classical 'coiled spring' of intussusception. The barium enema was unsuccessful as an attempt at hydrostatic reduction, but confirmed the diagnosis by a 'crescent-shaped' filling defect in the ascending colon. The patient was discharged after an uneventful surgery and recovery. No organic lesion that precipitated the chronic intussusception was discovered at operation. Radiological findings, the typical clinical picture and adequate treatment are discussed.

CT findings in neonatal hypothermia.

BACKGROUND: Newborn infants are particularly prone to hypothermia, a condition with a high mortality. OBJECTIVE: To study the CT brain patterns in infants with hypothermia and neurological symptoms. MATERIALS AND METHODS: We reviewed the brain CT of nine infants with neonatal hypothermia, multiple organ failure, seizures and coma. RESULTS: Two infants had normal CT scans, acutely and at follow-up, and were clinically normal at follow-up. In seven infants, CT showed diffuse cerebral oedema, with reversal of the normal density relationship between grey and white matter and a relative increased density of the thalami, brainstem and cerebellum - the 'reversal sign'. In six surviving infants with severe developmental delay, follow-up CT revealed cerebral atrophy with multicystic encephalomalacia. CONCLUSIONS: The 'reversal sign' has been described in the abused child, birth asphyxia and anoxia due to drowning. Neonatal hypothermia is offered as a further cause.

Ganglioneuroma: an 'incidentaloma' of childhood.

In adults clinically silent adrenal masses can be discovered incidentally in imaging studies. Most of these 'incidentalomas' are benign, non-functioning adenomas. In contradistinction, in infancy and childhood the most common adrenal mass is the neuroblastoma, a malignant neural crest tumour. Four children are described, each with a benign neural crest tumour - ganglioneuroma - incidentally discovered by conventional radiography or sonographic examination. Complete surgical excision resulted in total recovery of all the children.

[Chronic tophaceous gout].

A 51-year-old immigrant from the Caucasus had had chronic tophaceous gout for over 20 years, but had never been treated with anti-hyperuricemic drugs. He had developed large, multiple tophi in many locations, including both ankles and feet. The enormous size and unique location of the tophi caused considerable pain, and difficulty in standing and on walking. Since surgical removal of the tophi was refused by the patient, a course of allopurinol, 300 mg/day, was begun.