Symptomatic amyloid goiters: report of five cases.

BACKGROUND: Massive amyloid deposition in the thyroid to the point of goiter formation is rare. Here we describe the clinical presentation and outcomes of five patients with amyloid goiter (radiographically confirmed goiter in the context of tissue-proven thyroid amyloidosis) encountered in the past 23 years at our institution. METHODS: Mayo Clinic archives were searched between 1987 and 2010 for a diagnosis of "thyroid amyloidosis," "amyloid deposits," "amyloid deposition," or "liquid chromatography consistent with amyloid." Inclusion criteria were symptomatic thyromegaly; tissue confirmation of thyroid enlarged by amyloid deposits; and radiologic confirmation of thyroid enlargement. RESULTS: Five patients were identified who met all inclusion criteria. Amyloid goiter etiology included both primary and secondary amyloidosis, and the goiters ranged in weight from 50 to 130 g each. Diagnosis was made by fine-needle aspiration biopsy with Congo red staining and, if needed, spectrophotometry. All five patients had histories of persistent hoarseness for several years before presentation with compressive symptoms referable to their enlarging thyroids, and all had some degree of thyroid dysfunction (both hypothyroidism and hyperthyroidism) by the end of our follow-up period, which ranged from 5 months to 13 years. Two patients underwent surgical interventions, two were managed conservatively, and in one, the goiter shrank after systemic therapy for amyloidosis. CONCLUSIONS: Our clinical observations suggest slower goiter progression and a higher prevalence of thyroid dysfunction than previously thought.

CT enterography as a diagnostic tool in evaluating small bowel disorders: review of clinical experience with over 700 cases.

Computed tomographic (CT) enterography combines the improved spatial and temporal resolution of multi-detector row CT with large volumes of ingested neutral enteric contrast material to permit visualization of the small bowel wall and lumen. Adequate luminal distention can usually be achieved with oral hyperhydration, thereby obviating nasoenteric intubation and making CT enterography a useful, well-tolerated study for the evaluation of diseases affecting the mucosa and bowel wall. Unlike routine CT, which has been used to detect the extraenteric complications of Crohn disease such as fistula and abscess, CT enterography clearly depicts the small bowel inflammation associated with Crohn disease by displaying mural hyperenhancement, stratification, and thickening; engorged vasa recta; and perienteric inflammatory changes. As a result, CT enterography is becoming the first-line modality for the evaluation of suspected inflammatory bowel disease. CT enterography has also become an important alternative to traditional fluoroscopy in the assessment of other small bowel disorders such as celiac sprue and small bowel neoplasms.

Understanding interpretive errors in radiologists learning computed tomography colonography.

RATIONALE AND OBJECTIVES: To determine if interpretive errors in the course of learning CT colonography are secondary to failures in detection or in characterization and determine the types of lesions frequently missed. MATERIALS AND METHODS: Fifteen radiologists completed an electronic CTC training module consisting of two parts: 1) a teaching file demonstrating the varied appearances of polyps, cancers, and pitfalls in interpreting exams; and 2) a test of 50 complete CTC datasets. Following review of each test case, radiologists were asked to indicate if and where a polyp was visualized. The module then showed each neoplasm (if any) located within the dataset. For false negative examinations, radiologists indicated if the lesion was not seen, was seen but interpreted as colonic wall or fold, or was seen but interpreted as stool or fluid. RESULTS: The average sensitivity for sessile, pedunculated, and flat polyps for these novice readers was 76%, 63%, and 32%, respectively. Average sensitivity for all morphologies of cancers (annular, polypoid, flat) was high (93%, 85%, 95%), with 8/11 missed cancers being secondary to failure in detection. The most frequently missed cancer was an annular constricting tumor (5/11). Overall, 55% (73/132) of errors were failures of detection and 45% (59/132) were errors in characterization. CONCLUSION: Radiologists learning CT colonography had slightly more errors of detection than characterization, but this difference was not statistically significant. Flat and pedunculated polyps and annular constricting cancers were the most frequently missed morphologies. Examples of these abnormalities should be emphasized in CTC training programs.