Idiopathic hypertrophic cranial pachymeningitis: a case report.

Hypertrophic pachymeningitis is a rare fibrosing inflammatory process involving dura mater and tentorium. In this report we are presenting contrast enhanced MRI findings of an unusual case of pachymeningitis which presented with a periorbital mass due to dural sinuses occlusion and retrograde filling of periorbital veins through superior sagittal sinus.

Teleconferencing for cost-effective sharing of radiology educational resources: potential and technical development.

To develop a cost-effective method of sharing educational resources, a dial-up teleconferencing network was implemented between three radiologic sites for a 30-day period of evaluation. By means of standard dial-up telephone channels, compressed video and audio signals displayed radiologic images, slides, and text, allowing residents and faculty from the three sites to participate in sight and sound interactions. Each of the three sites used compressed video/audio coder-decoders (codecs) conforming to the Consultative Committee on International Telegraphy and Telephony H.261 standard. Four video cameras were used at each site, and the audio was run in full duplex mode. A multipoint video bridge was used to broadcast codec output signals to the input lines of the other codecs. Our evaluation found audio quality to be suboptimal, but capable of being improved; diagnostic image quality was adequate when a video zoom mode was used; the digital-archive mode of the codec proved advantageous; the H.261 codec permitted participation from all sites; and all conference lecturers were able to conduct their conferences as they were accustomed. Although audio quality and spatial resolution need to be improved, the results of this pilot study imply that dial-up compressed video conferencing has the potential to become a practical, cost-effective method of sharing educational resources by means of interactive radiologic multisite educational programs.

Giant-cell tumor of the sphenoid bone: case report and review of the literature.

We report the case of a 23-year-old man with a giant-cell tumor of the sphenoid bone. The radiologic manifestations consisted of an expansile mass arising from the sphenoid bone with extension into the cranial cavity and the nasopharynx. The findings with computed tomography and magnetic resonance imaging best reflected respectively the osseous and soft-tissue extent of the disease.

Delayed common femoral artery stenosis due to blunt trauma.

Arterial occlusion or stenosis due to blunt trauma is rare. Only isolated examples have been reported. The majority result from sport-related trauma or are iatrogenic in nature. The clinical importance of blunt trauma is that it can create delayed vascular stenosis but few symptoms at the time of the incident. This is even more important in children and adolescents as any delay in diagnosis can lead to severe sequelae such as limb shortening and other growth disturbances. We here report a patient with common femoral artery stenosis after a bicycle injury in whom, apparently uniquely, delayed symptoms developed after eight months.

Patterns of gallium uptake in amebic liver abscesses.

Imaging with Ga-67 and Tc-99m sulfur colloid was performed in ten patients with amebic liver abscesses. The most common imaging pattern appeared to be with the sharp identification of a "rim" sign on delayed Ga-67 imaging, from 48-72 hours.

Wilms tumor (nephroblastoma) in the adult patient: clinical and radiologic manifestations.

Wilms tumor (nephroblastoma), a primary renal neoplasm containing primitive blastema and embryonic glomerulotubular structures, is seen rarely in adults. To identify clinical and radiologic criteria for preoperative diagnosis of adult Wilms tumor, we studied 29 cases reported in the literature from 1975 to 1987 (all patients were 15 years old or older) and four newly diagnosed cases. The mean age of patients was 30 years; 80% were less than 35 years old. Each patient presented with a large, rapidly growing, abdominal mass (average duration of symptoms, less than 2 months), had no constitutional symptoms (e.g., weight loss, fever), and otherwise were healthy (80%). Twenty-six patients had IV or retrograde pyelograms. Twenty-three showed a nonspecific mass effect. In seven (78%) of nine patients, abdominal CT scans showed a large, inhomogeneous mass with large areas of low density and increased enhancement of the compressed remaining normal renal parenchyma, which resembled a pseudocapsule. In five (63%) of eight patients, sonograms showed a complex mass with large cystic components. In 18 (82%) of 22 patients, arteriograms showed a hypovascular mass with fine wavy or zigzag (creeping-vine) neovascularity. We conclude that a rapidly growing renal mass in a young patient (less than 35 years old) that is shown to be complex and cystic by CT or sonography and that is hypovascular with fine, wavy neovascularity on arteriography is suggestive of adult Wilms tumor (75-80%). An awareness of this constellation of findings may be helpful in diagnosing this unusual tumor before surgery.

Unusual sonographic appearance of a perforated appendiceal abscess.

In this report, the clinical and unusual sonographic manifestations of a perforated appendiceal abscess is described.

The value of immersion hand radiography in soft tissue changes of musculoskeletal disorders.

Immersion hand radiographs were performed on 25 patients with various clinical presentations and compared to plain radiographic studies of the hands. The immersion technique is superior in outlining the skin, subcutaneous fat layers, and fat layers between muscle planes. More important, this technique highlights the tendons and soft tissue components of the joint, which are hardly seen on standard hand radiographs. Immersion studies are therefore useful, both in the early diagnosis of erosive arthritis and in the follow-up of the course of the disease. They are recommended as an adjunct to conventional hand radiography in musculoskeletal disorders with soft tissue involvement.

Systematic errors in bone-mineral measurements by quantitative computed tomography.

Bone-mineral measurements using quantitative computed tomography (QCT) are commonly based on comparisons with solutions in water of known concentrations of K2HPO4. In this paper are described theoretical and experimental studies that have led to the conclusion that large systematic errors can arise in these measurements, depending on the soft-tissue and fat concentrations in the vertebral spongiosa. In the case of single energy scanning, such large errors have been identified to be due to the varying water content (displacement effect) in the calibration samples and the varying fat content in the region of interest (ROI) within the patient. In the case of dual energy scanning, the error arises because when normalized to that of water, the mass attenuation coefficient of fat increases with photon energy while the reverse is true for K2HPO4. Our studies have also revealed that total trabecular bone density (which includes the mineral, soft tissue, and fat) can be much more accurately determined by the dual energy QCT method than bone mineral alone. This finding is especially interesting since there have been several reports in the literature suggesting that bone density rather than bone-mineral content is a better predictor of the risk of osteoporosis-related fractures.

Incomplete carpal coalition.

Congenital coalition between the lunate and triquetrum is a common anomaly that may have several different radiographic appearances. We report seven patients with partial coalition and rounded radiolucencies in the subarticular region of both bones. The most likely cause of this combination of findings is abnormal differentiation of the joint space and remnants of misplaced synovial tissue that formed during the disorganized process of joint development.

Spine changes in neurofibromatosis.

The author illustrates the spinal changes of neurofibromatosis, distinguishing those that are primary and due to mesodermal dysplasia from those that are secondary to the effects of nerve sheath tumors.

The two-eyed Scotty dog: a normal anatomic variant.

An example of the "two-eyed Scotty dog," seen on the oblique radiograph of the lumbar spine, is presented. The second eye is created by a prominent mammillary process.

Computed tomography of malignant tumors of the osseous pelvis.

The medical records, conventional radiographs, bone scans and pelvic CT scans obtained in 50 consecutive patients with malignant lesions involving the osseous pelvis were retrospectively reviewed. In 21 patients with primary bone tumors or with osseous involvement from adjacent pelvic neoplasms, CT provided additional information, in 17 patients (80%) which had direct bearing in the clinical management. CT was less useful in 29 patients with bony metastases. Although more information was obtained, this was of clinical significance in only 12 patients.

Intra- and extraosseous xanthomata associated with hyperlipidemia.

Three cases of xanthomata associated with Type II and III hyperlipidemia are presented. A review of the radiologic manifestations of these and previously reported cases revealed that tendon xanthomata are more frequent than osseous ones. Osseous involvement is reported only in Type III hyperlipidemia and should be considered in the differential diagnosis of soft-tissue masses and bone marrow replacement disorders.

Plasmacytoma of the large bowel: a review of the literature and a case report of multiple myeloma involving the rectosigmoid.

Large bowel involvement is a rare manifestation of plasma cell tumors, especially in association with multiple myeloma. A review of the world literature reveals only 21 reported cases, the majority of which are classified as the solitary form of the disease. A case of multiple myeloma with rectosigmoid involvement is herein presented, and the radiological findings of reported cases are summarized.

Angiographic manifestations of soft-tissue and osseous hemangiopericytomas.

Hemangiopericytomas are rare vascular tumors and may originate wherever there are capillaries. So far, the author has found 341 cases of soft-tissue and 10 cases of osseous hemangiopericytomas. Only a few of these vascular tumors have been investigated angiographically. A review of 20 previously reported cases and 5 cases of his own, including a case of periosteal hemangiopericytoma, reveals that these are the only vascular tumors which present some characteristic angiographic features, regardless of their location or site of origin. Typically, a few feeder arteries enter the mass with radially arranged branching around and inside the tumor and a longstanding, well-demarcated tumor stain is seen.