ABSTRACT
Two cases of diaphragmatic pseudotumors in the right posterolateral pararenal space are reported to highlight their unusual location and their confusing computed tomographic pattern.
Subject(s)
Diaphragm/diagnostic imaging , Tomography, X-Ray Computed , Aged , Diagnosis, Differential , Diaphragm/pathology , Female , Humans , Hypertrophy , Kidney/diagnostic imaging , Kidney Neoplasms/diagnostic imaging , Male , Middle AgedABSTRACT
Thickening of the perirectal fascia (PRF) has been described as a CT sign of local extension of pelvic cancers. It has been observed also after radiation therapy and various pelvic surgical procedures. To demonstrate prospectively its nonspecificity, we systematically looked for such thickening before and after consecutive uneventful transurethral prostatic resections in 17 patients presenting with benign adenomas and in one patient with an unexpected prostatic carcinoma. In six patients (33%) obvious PRF thickening appeared on postoperative CT. Thus, this cause of fascial thickening must be considered when evaluating pelvic cancers.
Subject(s)
Fascia/diagnostic imaging , Postoperative Complications/diagnostic imaging , Prostatic Hyperplasia/surgery , Rectum/diagnostic imaging , Tomography, X-Ray Computed , Humans , MaleABSTRACT
Nuclear magnetic resonance (NMR) is based on the behaviour of some atomic nuclei when they are placed in a magnetic field and subjected to radiofrequency waves of a specific length. The resonance signals they emit under such conditions are collected as localized digital data which are used to construct an image. The signals vary according to multiple tissue characteristics, notably proton density, relaxation times T1 and T2 and, where applicable, blood flow direction and velocity. The relative influences exerted by these tissue factors on resonance signals can be evaluated by altering the technical parameters of the examination, that is practically the radiofrequency wave sequence. Special formulae make it possible to predict signal variations and to increase, decrease or even reverse contrast, thus obtaining as many morphological or functional images of the different media in the body. NMR semiology therefore is copious, complex and variable, but a diagrammatic description of the interplay between parameters provides a key to elementary analysis. Images of pelvic structures taken as examples illustrate the necessity to select the exploratory procedure according to the purpose of the exploration or to manipulate sequences with greater safety.
Subject(s)
Magnetic Resonance Spectroscopy , Pelvis/pathology , Adipose Tissue/anatomy & histology , Blood Vessels/anatomy & histology , Bone and Bones/anatomy & histology , Female , Humans , Intestines/anatomy & histology , Lymph Nodes/anatomy & histology , Male , Muscles/anatomy & histology , Prostate/anatomy & histology , Seminal Vesicles/anatomy & histology , Urine , Uterus/anatomy & histologyABSTRACT
The authors conducted a retrospective evaluation of the diagnostic value of nuclear magnetic resonance in comparison with other imaging techniques in a series of 28 pelvic tumours, with the exclusion of gastrointestinal tumours. The positive diagnosis of the lesion was obtained in every case. The variation of the signal provided information concerning the tissues, while the sections in three planes, the spontaneous visibility of the vessels and the very good natural contrast related to the presence of fat which gives a high signal, facilitated staging of the tumour.
Subject(s)
Magnetic Resonance Spectroscopy , Prostatic Neoplasms/diagnosis , Urinary Bladder Neoplasms/diagnosis , Bone Neoplasms/diagnosis , Bone Neoplasms/secondary , Humans , Male , Prostatic Hyperplasia/diagnosis , Urinary Bladder Neoplasms/pathologyABSTRACT
The preoperative distinction between renal cyst and tumor has long been a dilemma. A cystic renal adenocarcinoma may appear similar to a largely necrotic tumor or a cancer incorporated into a cyst or arising from a cyst wall. Overall, these cystic cancers present the same preoperative features. In our series of 15 cases, the characteristic pattern on computed tomography scans included size greater than or equal to 10 cm, localized thickening of cyst walls with contrast enhancement, and irregularly and poorly defined implantation in the kidney.
Subject(s)
Adenocarcinoma/diagnostic imaging , Kidney Diseases, Cystic/diagnostic imaging , Kidney Neoplasms/diagnostic imaging , Diagnosis, Differential , Humans , Kidney/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
We diagnosed by computerized tomography 15 local recurrences in 88 patients who had undergone nephrectomy for renal cancer, with no false positives and 1 false negative. This over-all low rate (17 per cent) probably is owing to the fact that computerized tomography scans were done in patients in good clinical condition. Local recurrence was noted in 3 of 59 asymptomatic patients and in 12 of 19 patients with local symptoms. No recurrence was noted in 10 patients with general symptoms. Thus, 20 per cent of local recurrences were asymptomatic and 80 per cent presented with local symptoms. High local recurrence rates were found in cases of transitional cell carcinoma with whole wall involvement or extension to adjacent tissues (4 of 8 patients, 50 per cent), clear cell adenocarcinoma with lymph node involvement (3 of 7 patients, 43 per cent) and partial nephrectomy (3 of 6 patients, 50 per cent). Therefore, we consider such patients to be at high risk. Our study demonstrates that computerized tomography enables earlier, accurate diagnosis of smaller local recurrence in asymptomatic patients and provides a sensitive, reliable, noninvasive, repetitive method of evaluation of clinical treatment trials. Routine followup should be reserved for high risk patients.
Subject(s)
Kidney Neoplasms/surgery , Neoplasm Recurrence, Local , Nephrectomy , Adenocarcinoma/diagnostic imaging , Adenocarcinoma/surgery , Adult , Aged , Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/surgery , Carcinoma, Transitional Cell/diagnostic imaging , Carcinoma, Transitional Cell/surgery , Female , Humans , Kidney Neoplasms/diagnostic imaging , Male , Middle Aged , Tomography, X-Ray Computed , Wilms Tumor/diagnostic imaging , Wilms Tumor/surgeryABSTRACT
On computed tomography, the kinking of a large ureter may falsely suggest an ureteral tumor. This pitfall likely correlates with the intraluminal protrusion of the ureteral wall folds.
Subject(s)
Tomography, X-Ray Computed , Ureteral Neoplasms/diagnostic imaging , False Positive Reactions , Female , Humans , Middle Aged , Ureter/diagnostic imaging , UrographyABSTRACT
An atypical pattern of pericardial cyst was observed on a routine chest radiograph of a healthy 25-year-old woman. It appeared as an important elevation of the right diaphragm. The cystic nature of the mass was easily disclosed by ultrasonography and computed tomography, but its location--thoracic, diaphragmatic, or subphrenic--remained questionable. Finally, a percutaneous puncture yielded 1300 mL of clear liquid. Despite this huge volume, the cyst had been asymptomatic and did not recur after complete aspiration. Retrospectively, owing to previous files, we could recognize the evolution of a pericardial cyst from the age of 13 years. At that time, it was much smaller and was evaluated by a series of aggressive investigations, although it had a more typical pattern and was confined to the right cardiophrenic angle.
Subject(s)
Mediastinal Cyst/diagnostic imaging , Adult , Drainage , Female , Follow-Up Studies , Humans , Mediastinal Cyst/diagnosis , Mediastinal Cyst/therapy , Punctures , Time Factors , Tomography, X-Ray Computed , UltrasonographyABSTRACT
Computed tomography (CT) gives an excellent opportunity to revisit normal anatomy and to understand pathological aspects. Renal fascia alterations, on CT scans, are a sensitive sign of local lesion. While a thin renal fascia has no pathological significance, any thickening may be considered abnormal although nonspecific. It is found in pancreatitis as well as in cancer of the pancreas, in renal tumors as well as in pyelonephritis. It may persist as a scar. On the other hand, lack of fascial thickening allows us to rule out renal extension of a neighboring lesion or to decide that a renal mass is an ancient slowly-growing benign one.
Subject(s)
Kidney Diseases/diagnostic imaging , Tomography, X-Ray Computed , Abscess/diagnostic imaging , Diagnosis, Differential , Humans , Kidney Neoplasms/diagnostic imaging , Pancreatic Neoplasms/diagnostic imaging , Pancreatitis/diagnostic imaging , Pyelonephritis/diagnostic imaging , Radiographic Image Enhancement , Radiographic Magnification , Retroperitoneal Neoplasms/diagnostic imaging , Retroperitoneal SpaceSubject(s)
Carcinoma, Transitional Cell/diagnostic imaging , Kidney Calculi/diagnostic imaging , Kidney Calices/diagnostic imaging , Kidney Neoplasms/diagnostic imaging , Kidney Pelvis/diagnostic imaging , Adult , Aged , Female , Hemorrhage/diagnostic imaging , Humans , Kidney Diseases/diagnostic imaging , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
The use of computed tomography (CT) versus aortography is evaluated in a limited study of 17 cases of aortic dissection (AD). With the constraints of the present state of the technology and lack of availability of CT scanners at some centers, aortography remains the premier and often the only diagnostic test to choose in an emergency. CT, however, may be an asset in the diagnosis of AD when: (1) atypical or misleading clinical presentations are evident that do not require aortography; (2) aortography is contraindicated in a weakened patient, when there is no emergency; (3) aortography is a risk while there is a strong suggestion of AD; (4) patency of a false channel must be confirmed. These circumstances were encountered in five patients. In addition, a localized infrarenal AD was fortuitously discovered in two patients presenting with abdominal visceral cancer. On patient follow-up, CT is less invasive and may be performed in asymptomatic patients undergoing treatment, thereby facilitating the early detection of complications. Detailed computed tomograms often yield superior diagnostic information only if the CT study includes rapid sequential scans immediately following a fast intravenous bolus of contrast material.
Subject(s)
Aortic Aneurysm/diagnostic imaging , Aortic Dissection/diagnostic imaging , Aortography , Tomography, X-Ray Computed , Aged , Humans , Male , Middle AgedABSTRACT
Three cases of multilocular cystic nephroma (MNC) tht were demonstrated by computed tomography (CT) are described. In two cases a correct preoperative diagnosis was made. In the third case, however, the mass did not fit exactly the histologic criteria for MCN. MCN appears on CT scans as a well-marginated, rounded, or polycyclic cortical mass that extends beyond the normal renal outline. This mass contains cysts that vary in size and number. It may be a cluster of a few large cysts with thick walls and septa, or it may be a denser mass composed of tiny cysts. This CT pattern is suggestive of MCN, but is not sufficient to obviate surgery. However, as part of a complete preoperative evaluation including arteriography, CT provides information that may be valuable in limiting the surgical procedure, perhaps avoiding unnecessary nephrectomy.