Recurrent Pott's puffy tumor - atypical presentation of a rare disorder.

We report the case of a 14-year-old girl who presented with an 8-week history of unilateral pansinusitis. In the course of the disease a right-side frontal swelling was observed, which disappeared following antibiotic treatment. Four weeks later, however, the swelling reappeared and was now diagnosed as recurrent Pott's puffy tumor. Interestingly, C-reactive protein levels were in the normal range throughout. Following functional endoscopic frontal sinusotomy, antibiotic treatment with ceftriaxone was administered over 3 weeks and led to complete remission of the lesion. Pott's puffy tumor is a subperiostal abscess of the frontal bone, usually presenting as localized swelling of the soft tissue in the overlying region of the forehead, and is associated with localized osteomyelitis and occasionally with intracranial epidural abscess. The entity has been known since 1768, although recurrent cases with normal inflammation parameters have not been published previously.

Differentiation of renal clear cell carcinoma and renal papillary carcinoma using quantitative CT enhancement parameters.

OBJECTIVE: The purpose of our study was to evaluate quantitative multiphasic CT enhancement patterns of malignant renal neoplasms to enable lesion differentiation by their enhancement characteristics. We used a new method to standardize enhancement measurement in lesions on multiphasic CT not being influenced by intrinsic factors like cardiac output. CONCLUSION: The new correction method is a simple tool for excluding intrinsic influences on the enhancement of lesions. Quantitative enhancement evaluation with this method of the influence of intrinsic factors enables accurate differentiation between renal clear cell carcinoma and renal papillary carcinoma.

Improvement of parenchymal and vascular enhancement using saline flush and power injection for multiple-detector-row abdominal CT.

The aim of this study was to determine if a saline solution flush following low dose contrast material bolus improves parenchymal and vascular enhancement during abdominal multiple detector-row computed tomography (MDCT). Forty-one patients (24 men and 17 women; mean age 49 years, age range 27-86 years) underwent abdominal MDCT (collimation 4x5 mm, 15-mm table increment, reconstruction interval 5 mm, gantry rotation period 0.8 s) with a single- as well as with a double syringe power injector. Indication for examination were benign and malignant tumors and inflammatory diseases. Patients received 100 ml nonionic contrast material (300 mgI/ml) alone or pushed with 20 ml saline solution. Mean enhancement values for both protocols were measured in the liver, the spleen, the pancreas, the renal cortex, the portal vein, the inferior vena cava and the abdominal aorta. Double syringe power-injector protocol led to significantly higher parenchymal and vascular enhancement than single syringe power-injector protocol (p<0.05). The improvement in mean enhancement of the liver was 9 +/- 9 HU, of the spleen 8 +/- 10 HU, of the pancreas 7 +/- 9 HU, and of the renal cortex 8 +/- 20 HU. The improvement in mean enhancement of the portal vein was 10 +/- 17 HU of the inferior vena cava 8 +/- 13 HU and of the abdominal aorta 10 +/- 17 HU. The use of a double syringe power injector with saline flush following contrast material bolus significantly improves parenchymal and vascular enhancement during contrast-enhanced abdominal MDCT with low iodine doses.

Abdominal multidetector row computed tomography: reduction of cost and contrast material dose using saline flush.

OBJECTIVE: To evaluate the potential of a saline solution flush after the contrast material bolus in abdominal multidetector row CT (MDCT) in contrast material dose and cost reduction. METHODS: Abdominal MDCT was performed in 78 patients who were assigned randomly to 2 groups receiving 120 mL nonionic contrast material (300 mgI/mL) alone or 100 mL of the same contrast material pushed with 40 mL of saline solution. Mean attenuation values for both groups were measured in the liver, the spleen, the pancreas, the portal vein, the inferior vena cava, and the abdominal aorta. Cost analyses were performed for both groups. RESULTS: There was no significant difference in parenchymal and vascular enhancement between both groups. The difference of the enhancement was 2 HU for the liver (P = 0.11), 2 HU for the spleen (P = 0.44), 3 HU for the pancreas (P = 0.38), 9 HU for the portal vein (P = 0.11), 3 HU for the inferior vena cava (P = 0.55), and 10 HU for the aorta (P = 0.06). Taking the costs of contrast material, saline solution, and disposal material into account, 7.30 dollars was saved by the patient using a saline solution flush. CONCLUSIONS: Using a saline flush after the contrast material bolus in abdominal MDCT allows an iodine dose reduction of approximately 6 g, or 17%, without impairing mean parenchymal and vascular enhancement and a cost reduction of 7.30 dollars per patient.

Findings and clinical course of a localized primitive peripheral neuroectodermal tumor of the kidney.

Primitive neuroectodermal tumor (PNET) is a very aggressive neoplasm, considered to have an unfavorable prognosis, and renal location is extremely rare. We present the findings and clinical course of a patient with localized disease who is free of disease more than 3 years after first presentation. In suspicious cases we recommend to surgically explore renal masses as early as possible.