Atypical alveolar proteinosis.

Alveolar proteinosis is a rare pulmonary disease characterized by intra-alveolar accumulation of surfactant composed of lipoproteinaceous material, related to a lack of surfactant resorption by alveolar macrophages. Crazy paving pattern is characteristic, but not specific. The multinodular forms of this affection remain exceptional.

Endoscopic treatment of vesicoureteral reflux--a 20-year follow-up.

Endoscopic reflux therapy has gained more and more popularity, and the use of this method is increasing. These imaging patterns (well known by pediatric radiologists) should be known by the general radiologist as the first young patients treated 20 years ago are now adults.

Giant ameloblastoma.

Ameloblastoma is the most frequent of the odontogenic tumors. We report a case of a giant ameloblastoma involving the maxillary region and describe its ultrasonography and computed tomography findings.

Reversible uro-lymphatic fistula.

Renal lymphatic fistulas are rare and, in most cases, of parasitic origin. We report a case of a reversible uro-lymphatic fistula, which was demonstrated by CT and was felt to be secondary to a radiolucent calculus.

Uterine inversion caused by a submucous leiomyoma.

Uterine inversion secondary to a pathological process of the myometrium is very rare. We report the case of a woman presenting with a submucosal pedunculated leiomyoma in whom a study by 3-T magnetic resonance imaging (MRI) demonstrated a uterine inversion. The MRI findings were characteristic and permitted a correct diagnosis before the surgical intervention.

Solitary intraperitoneal fibrous tumor: report of three cases.

The solitary intraperitoneal fibrous tumor is a rare lesion, almost exclusively benign. We report on three cases with different ultrasound, computed tomography and magnetic resonance imaging findings, related to the fibrous and/or cellular histological composition of the tumor. Because of the minimal, but real, possibility of a recurrence after the surgical intervention, a follow-up by radiological imaging is recommended.

Two rare cases of spontaneous splenic rupture.

The rupture of the spleen, not secondary to external trauma, is rare. Two cases are reported. The first case occurred in a patient with an aggressive form of lymphoma, and the second in a patient following a colonoscopy. In the rare occurrences of spontaneous rupture, radiological imaging, in particular by computed tomography, will lead to the diagnosis and help in deciding the correct treatment.

Endometriosis following cesarean section: ultrasonography and magnetic resonance imaging.

We present three cases of endometriosis developing in the abdominal wall following cesarean section. The patients were examined by Doppler ultrasonography (US) and magnetic resonance imaging (MRI). The object is to describe the US and MRI findings of the lesion and evaluate their role in the diagnosis and management. In our opinion, a single procedure is sufficient in evaluating the lesion and in reaching the diagnosis.

CT-guided biopsy in two cases of retroperitoneal fibrosis.

Diffuse retroperitoneal fibrosis (RPF) is a rare inflammatory process. We report on two known cases of RPF, without evidence of involvement of the urinary tract or of the venous system. A computed tomography (CT)-guided biopsy was performed in each case, and the histological findings eliminated other pathological processes, particularly those of malignant origin. In both cases, a therapy with cortisone was instituted, and a follow-up with CT at 6 months has demonstrated a regression of the pathology of more than 50%.

Lipomas of the right colon: report on six cases.

We report six cases of lipomas of the right colon, of which one was affected by two lesions. Two cases presented with episodes of partial occlusion; the others did not present with particular symptoms. The diagnoses were based on imaging by computed tomography, which demonstrated an intraluminal formation of fatty density, not associated with tissual components or hypervascularization.

Colocolic tumoral intussusception in the adult: value of multi-slice spiral CT imaging.

Colocolic intussusception in the adult, caused by a tumoral process, is a rare clinical event. We have studied two adults clinically presenting with a mass in the right iliac fossa, which was produced in one case by a carcinoma involving the right colon and in the other case involving the sigmoid. Multi-slice spiral CT imaging showed the presence of a colocolic intussusception-the tumoral characteristics of the lesion eliminated the possibility of a lipoma-and it allowed a satisfactory presurgical evaluation of the pathological process.

Lipomatous tumors of the adrenals--a report on 18 cases and review of the literature.

The lipomatous tumors of the adrenals are hormonally inactive lesions, often of a benign nature, such as myelolipomas, lipomas, angiomyolipomas, or mature teratomas, and are rarely malignant, such as liposarcomas. The importance of recognizing their characteristic radiological images, which would lead to their correct treatment, is fundamental since there has been an increase in the demonstration of this lesion, often detected incidentally. The various imaging procedures, although not allowing to formulate a histological diagnosis, nonetheless permit to determine the volume of the tumoral mass and their evolution. These two factors are of significant importance in the planning of the correct surgical procedure, while a third important factor is the proper evaluation of the symptoms presented by the patient. Regarding the treatment, on the basis of our own experience, which agrees with that of other authors, the surgical removal of any lesion greater than 5 cm is mandatory.

Subumbilical parietal cystic images.

We report three cases of women who came to our observation suffering from a feeling of heaviness in the pelvic floor. Ultrasonography showed, in all cases, a cystic formation, medially located under the umbilicus, suggesting the presence of a cyst of the urachus. Computed tomography and magnetic resonance imaging, however, thanks to a more definite topographic evaluation, allowed elimination of this diagnosis in two patients with history of previous abdominal surgery.

Torsion of a uterine leiomyoma: MRI features.

We report a case of a patient admitted to our hospital for acute pelvic pain. Ultrasounds and abdominal CT scan found a voluminous mass situated in the upper urinary bladder and contiguous to the uterus and to the ovaries. Magnetic resonance imaging identified a pedicle connecting the uterus to the mass which had an aspect of a necrobiotic leiomyoma. Laparoscopic surgery confirmed the diagnosis of acute torsion of a subserous uterine leiomyoma.

Can low-dose computed tomographic scan of the spine replace conventional radiography? An evaluation based on imaging myelomas, bone metastases, and fractures from osteoporosis.

We evaluated and compared the radiological images of the spine of 111 patients affected by myeloma, bone metastases, and fractures secondary to osteoporosis demonstrated in low-dose computed tomographic (CT) scans and those demonstrated in conventional radiographic studies. From the analysis of the data obtained, it appears that the duration of the CT procedure is definitely shorter and that its diagnostic sensitivity is superior to that of conventional radiography. We should mention that the dose of radiation delivered by CT scanning does not constitute an unfavorable element in patients, usually elderly, for whom CT scanning was indicated.

Aortic embolism of cement: a rare complication of lumbar percutaneous vertebroplasty.

An aortic embolus of cement occurred in a 72-year-old woman after lumbar percutaneous vertebroplasty for breast cancer metastasis. A CT scan during the procedure revealed cement migration into the aorta via the lumbar artery. The cement embolus in the aorta, along with the hook-shaped cement fragment in the lumbar artery, was asymptomatic. Thereafter, a CT scan 4 months later still showed the presence of cement in the aorta and the lumbar artery at the level of the vertebroplasty. The patient is free of complaints after 4 months without anticoagulant treatment. This rare complication occurred because the collateral arterial supplies to the breast metastasis and the retrograde migration of cement during the vertebroplasty were not recognized. Proper techniques can minimize the risk of arterial embolism caused by cement during the procedure.

Atypical MRI features of a biliary cystadenoma revealed by jaundice.

We report on the case of a patient admitted for epigastric pain. An abdominal ultrasound revealed a voluminous cystic lesion of the left hepatic lobe. In magnetic resonance imaging, the mass had a liquid-liquid level that was spontaneously hyperintense on T(1)-weighted images and hypointense on T(2)-weighted images. Magnetic resonance cholangiography identified bilateral intrahepatic bile duct dilatation. A left hepatectomy finally revealed a mucinous cystadenoma with pseudo-ovarian stroma that had a pedunculated intraductal extension to the biliary convergence.

Inguinal herniation of a bladder diverticulum.

The inguinal herniation of a bladder diverticulum is a rare entity. We report two cases and describe the findings observed by computed tomography, which allowed demonstration of the site and contents of the hernia.

Clinical follow-up of 50 patients treated by percutaneous lumbar discectomy.

A series of 50 patients presenting with lumbar discogenic disease, and treated by percutaneous discectomy using the Dekompressor system (Stryker, Kalamazoo, MI, USA), were followed for more than 6 months, by analyzing the evolution of the painful symptomatology with the visual analog scale (VAS) system. All patients had been under treatment with analgesic or anti-inflammatory agents. The intensity of the pain was measured 2, 7, 30, and 180 days after the percutaneous discectomy. An improvement in the painful symptomatology of less than 30%, observed in 11 cases and in 1 case of epidural pathology, was considered an unsuccessful result. A decrease of the pain of more than 70% was observed in 72% of cases, either with the end of the symptoms of pain as noted in 79.5% of patients or with a marked reduction of the medical treatments obtained in 21.5%. The results obtained were already almost definitive at the seventh day of follow-up, and further controls rarely demonstrated an improvement in the pain. The location of the herniated disc is a parameter which appears to be very important in the efficacy of percutaneous discectomy. We noted an improvement of more than 70% in 79% of the posterolateral foraminal or extraforaminal hernias, although these favorable results were observed only in 50% of the posteromedian hernias.

Shoulder distension arthrography in adhesive capsulitis.

Capsular retraction of the shoulder often occurs as a solitary pathological process; half of the cases are of primitive nature. In the past 10 years or more, distension of the shoulder joint has proven to be an efficient percutaneous treatment, and various techniques have been proposed. We report on our technique, which was performed on a series of 200 patients, and on the results observed in 27 patients with a precise evaluation of progressive changes in movements of the joint.