CT appearance of solitary and multiple cystic and cavitary lung lesions.

Cystic and cavitary lung lesions constitute a spectrum of pulmonary diseases diagnosed in both children and adults. We reviewed the CT findings of the most common cystic and cavitary lung lesions and we defined useful morphological criteria that will help radiologists to distinguish benign from malignant cavitary lesions. However, in many cases the considerable overlap in morphological features of benign and malignant cavities renders transthoracic needle biopsy necessary to establish the correct diagnosis.

The radiology of the thoracic manifestations of AIDS.

The thoracic manifestations of AIDS have undergone a gradual metamorphosis, partly due to more awareness about the disease leading to earlier diagnoses and partly due to the fact that research has produced more effective prophylaxis as well as treatment for these patients. Many patients now demonstrate partial or complete clinical response which prolongs the length and quality of life of individuals positive for the Human Immunodeficiency Virus (HIV+). Also, with the large number of infected individuals coming to medical attention, and the years of experience in diagnosing and treating these AIDS patients, we now recognize not only the usual but also less usual manifestations of thoracic illnesses in AIDS, including infections, non-infectious diseases such as HIV associated Lymphocytic Interstitial Pneumonia and the neoplasms associated with AIDS. A section will be devoted to HIV infection in children. We will finish the article with a discussion of the current role of Nuclear Medicine in the diagnosis of HIV associated thoracic diseases. These topics are the subject of this article.

Diagnosis of injuries of the aorta and brachiocephalic arteries caused by blunt chest trauma: CT vs aortography.

OBJECTIVE: The purpose of this study was to evaluate the role of chest CT in the triage of patients with potential injuries of the aorta and brachiocephalic arteries caused by blunt trauma and to test the value of chest CT scans in limiting the number of screening aortograms. SUBJECTS AND METHODS: A prospective study was done with 107 patients who were examined because of possible laceration of the aorta or brachiocephalic vessels. Chest radiographs were obtained in 107 patients, aortograms in 105, and chest CT scans in 90. This evaluation concentrates on the 88 patients who had both CT and aortography. Findings on CT scans were categorized as normal, equivocal, suggestive of, subtly positive for, or grossly positive for mediastinal hematoma. RESULTS: Findings on CT scans were considered normal in 18 patients. Sixteen had normal aortographic findings. Two of the 18 had clinical follow-up without aortography. Findings on CT scans were considered equivocal in 25 patients, suggestive of hematoma in 13, subtly positive for hematoma in 24, and grossly positive for hematoma in 10. Subsequent aortography showed injuries in four patients who had abnormal CT findings. Nineteen other patients had aortography because of grossly abnormal findings on chest radiographs, and one aortic injury was detected. CONCLUSION: The value of chest CT as a preliminary procedure to avoid thoracic aortography in patients with blunt trauma was limited in our series. Chest CT scans with normal findings effectively exclude aortic/brachiocephalic injury; however, only about 25% of our patients had chest CT scans with unequivocally normal findings, and most patients required further evaluation with aortography.

Hypertrophic pyloric stenosis in the neonate--diagnostic criteria revisited.

The authors analysed 45 ultrasonography (US) studies of 43 infants with surgically confirmed hypertrophic pyloric stenosis (HPS) to ascertain whether the current US criteria for pyloric stenosis are applicable to all infants, including those 30 days of age and younger. Most articles in the radiologic literature cite a muscle thickness of 4 mm or greater and a pyloric canal length of 17 mm or greater as diagnostic of HPS. However, the results of this study suggest that in infants 30 days of age or younger the muscle thickness considered diagnostic for HPS be 3 mm or greater.

Metastasis to the bladder from pancreatic adenocarcinoma presenting with hematuria.

Pancreatic adenocarcinoma infrequently involves the urinary tract. Hematuria may result from either direct invasion of the kidneys or from metastases to the urinary tract. The bladder may be involved in the late stages from metastases, but rarely is it associated with hematuria since mucosal involvement is very unusual. We report a second case of bladder metastases and hematuria as a presenting symptom of pancreatic carcinoma.

Comparison of transvaginal and transabdominal ultrasonography in ectopic pregnancy.

The authors retrospectively reviewed 45 consecutive cases of proven ectopic pregnancy for which both transvaginal (TV) and transabdominal (TA) ultrasonography had been performed to compare the diagnostic efficacy of the two imaging techniques. The criteria for a diagnosis of ectopic gestation included an extrauterine gestational sac containing a fetus or a fetal pole, or an empty extrauterine sac. Solid or complex adnexal masses with evidence of hemoperitoneum were considered suggestive but nondiagnostic. TV ultrasonography was superior to TA ultrasonography in 22 cases (49%) and inferior in 3 (7%). In the remaining 20 cases (44%) the two methods yielded similar information. For cases in which TV ultrasonography was superior, this method provided clear evidence of ectopic pregnancy in 11 cases in which TA ultrasonography demonstrated nonspecific masses or normal adnexa; in the other 11 cases both methods led to the correct diagnosis, but TV ultrasonography provided additional useful information. The authors conclude that TV ultrasonography has a definite role in improving the diagnosis of ectopic pregnancy.

Massive hepatic necrosis in the HELLP syndrome: CT correlation.

We present a patient with toxemia of pregnancy and the HELLP syndrome [hemolysis (H), elevated liver enzymes (EL), and a low platelet count (LP)] resulting in massive hepatic necrosis. Cross-sectional imaging, including sonography, computed tomography, and nuclear medicine, was instrumental in the diagnosis and differentiation from hepatic abnormalities of other pregnancy related entities especially acute fatty liver of pregnancy.

Transvaginal sonographic evaluation of the retrodisplaced uterus.

To determine the clinical value of transvaginal sonography in the assessment of retrodisplaced uteri, the authors reviewed, retrospectively, 500 consecutive transvaginal (TV) and transabdominal (TA) sonograms. Of the 494 patients examined, 27 had a retrodisplaced uterus. Transvaginal sonography was superior to TA sonography in 25 patients, providing improved visualization of the endometrial canal, myometrium, adnexa and cul-de-sac. In 7 of these 25 patients, the findings that suggested the diagnosis were only seen on TV scanning. These findings included intrauterine pregnancy (three patients), fluid collection in the cul-de-sac (two patients), fluid collection in the endometrial canal (one patient) and an embedded intrauterine contraceptive device (one patient). The two techniques yielded the same information in two other patients. In no patient was TA sonography more informative than TV sonography. The authors, therefore, conclude that TV sonography is the procedure of choice in assessing a retrodisplaced uterus and that additional examination with TV sonography is advisable whenever a retrodisplaced uterus is suspected.

Phrenic nerve injury during coronary artery bypass.

After coronary artery bypass, some patients have diaphragmatic elevation, usually on the left side. To test our hypothesis that this phenomenon is due to phrenic nerve injury resulting from either 1) dissection of the proximal portion of the left internal mammary artery or 2) topical cooling of the heart with icy slush, we performed the following 2-part study. First, we reviewed our hospital records of 99 coronary artery bypass patients, 55 of whom had received left internal mammary artery grafts and 44 of whom had undergone saphenous vein grafting; the results showed no significant difference between the rates of left-sided diaphragmatic paralysis in the 2 groups (47% versus 41%, respectively). Next, we performed a prospective, randomized study in 100 consecutive patients, using a cardiac insulation pad to protect the left phrenic nerve in 58 patients and using no protective pad in 42 patients. At the time of hospital discharge, left-sided diaphragmatic elevation was seen in 6 (10.3%) of the 58 patients in whom insulation had been used and in 19 (45.2%) of the 42 patients whose phrenic nerve had been unprotected (p < 0.001). We conclude that cooling of the left phrenic nerve with icy slush in the pericardial cavity causes left-sided diaphragmatic paralysis and that the frequency of this injury can be reduced if a cardiac insulation pad is placed between the nerve and the icy slush.

The many faces of neuroblastoma.

Neuroblastoma is a common tumor in childhood. It arises in the adrenal gland or in various extraadrenal primary sites of the sympathetic chain. Clinically, it may present as an abdominal mass or as disseminated metastatic disease. We studied 52 patients with neuroblastoma, and the typical and unusual radiographic features of the disease are presented.

Aggressive infantile fibromatosis. Pulmonary metastases documented by plain film and computed tomography.

Aggressive infantile fibromatosis, one of the juvenile fibromatoses, is generally considered a benign lesion, but it does tend to recur locally because of its invasive nature. Distant metastases are considered rare. This case report documents pulmonary metastases arising 2 years after resection of the primary lesion from the thigh of an infant. This is the seventh reported case of distant metastasis from aggressive infantile fibromatosis. Computed tomography of the original lesion as well as the metastases are presented.

Bladder diseases and imaging methods.

New and exciting diagnostic modalities which substantially change the evaluation of the urinary bladder have become available in the last decade. This is a review of the principles involved in and the advantages of diagnostic imaging using the modalities available to study the urinary bladder in a modern radiologic facility. It emphasizes the values of the different modalities in specific disease states. Excretory urography, cystography, and voiding cystourethrography were the mainstay of the evaluation of bladder pathology. These modalities are still good screening methods under certain circumstances but are relatively limited in comprehensive assessment of the bladder. Bladder studies using radionuclides, such as nuclear cystography, still have a space in the long-term follow-up of pediatric patients due to their relative low radiation dose. Since the addition of ultrasonography, computed tomography, and more recently, magnetic resonance imaging to the radiologist's armamentarium of imaging modalities, there has been a tremendous improvement not only in the demonstration of bladder abnormalities, but also in the staging of bladder neoplasms. The relative merits of these past and present imaging modalities are illustrated. Their appropriate contributions to improved quality of care of patients with bladder disease are also discussed.

Abdominal cryptococcoma in AIDS: a case report.

Cryptococcosis is a recognized opportunistic pathogen in the acquired immune deficiency syndrome. Although central nervous system infection and disseminated cryptococcosis is common in acquired immune deficiency syndrome, localized infection is rare. We present a case of massive retroperitoneal and mesenteric adenopathy in a male homosexual patient with acquired immune deficiency syndrome with clinical and radiologic features suggestive of lymphoma. However, this was proven pathologically to represent cryptococcal infiltration of the lymph nodes. Our experience indicates that Cryptococcus neoformans should be included in the differential diagnosis of massive abdominal adenopathy in the acquired immune deficiency syndrome.

Sonographic findings in traumatic hemobilia: report of two cases and review of the literature.

Hemobilia consists of an arteriobiliary fistula, usually due to central liver rupture with bleeding into the biliary tree. It is due to trauma in over 50% of cases, with an increasing incidence of iatrogenically caused hemobilia. The sonographic findings in two cases of traumatic hemobilia are presented and the literature is reviewed. These findings include clot within the gallbladder and the extrahepatic ducts, liver hematoma, and aneurysm of the hepatic artery.

Role of computed tomography in diverticulitis.

Fourteen patients with diverticulitis who were clinically believed to require radiologic investigation form the basis of this report. An inflammatory mass (n = 10) or abscess (n = 2) were reliable findings on computed tomography. Other signs encountered were abnormal density of pericolic fat, thickening of colonic wall, and narrowing of the lumen of the colonic wall. Colovesical fistulas, all of which were suspected clinically, occurred in three patients. Computed tomography should be performed with administration of rectal contrast medium to demonstrate the origin of inflammation from the colon, assess pericolic extent, and confirm colovesical fistula.

CT demonstration of preferential routes of the spread of pelvic disease.

Specific anatomical pathways, both extraperitoneal and intraperitoneal, exist which result in the spread of disease into or out of the pelvis. Often, the full extent of the disease is not appreciated clinically and may be uncovered first by computed tomography (CT). This review discusses the pertinent normal anatomy as shown by CT and magnetic resonance (MR) and then illustrates each route with examples. An awareness of these preferential routes of disease spread permits the radiologist monitoring the examination to decide when areas adjacent to the pelvis should be included in the study. This will provide a complete assessment of the extent of disease and guide appropriate therapy.