Cholesterol granuloma coincidence with a large and high jugular bulb: report of a case.

We present a case of right middle ear mass who had an abnormal large jugular foramen, high jugular bulb and large jugular vein on the same side. CT scan could not exclude a glomus tumor. Theoretically, retrograde jugular venography and carotid angiography will give the most useful information. However, in this case we tried to use the MRI scan instead. It showed high signal in T1W, T2W, GRT2W which correlated with blood pigments of methemoglobin in middle ear and mastoid. The low signal in MRI scan T1W, T2W clearly showed enlarged jugular vein, high jugular bulb with diverticulum which helped to excluding a glomus tumor. This finally turned out to be a cholesterol granuloma coincidence with abnormal enlarged jugular foramen and jugular vein. We suggest the MRI scan is very helpful and much safer for patients compared to angiography.

Changes in T-staging of nasopharyngeal carcinoma by CT-scan.

To evaluate the value of computerized axial tomogram (CT-scan) of the nasopharynx in the management of patients with nasopharyngeal carcinoma (NPC), comparisons between clinical T-staging by means of indirect or direct nasopharyngeal examination, and CT-scan were performed in 101 cases. CT-scan has upstaged clinical T-staging in 83.9 per cent of Tx-T3 cases, or 80 per cent in Tx, 98 per cent in T1, 65.4 per cent in T2, and 50 per cent in T3 cases. CT-scan was also able to show the destruction of the base of the skull in 85.7 per cent of T4 cases. With regard to tumor extensions into the surrounding regions, the CT-scan proved to out-perform clinical T-staging by 82.2, 57.4, and 25.7 per cent respectively in superior, anterior, and lateral and inferior extensions. We, therefore, recommend that a CT-scan be done in every new case of NPC, because it provides more accurate T-staging, and more details of tumor extension, which is essential in the management of NPC, especially in the proper planning of radical radiotherapy.

Moyamoya disease: a report of four cases of Thai children.

Moyamoya disease is a cerebrovascular disorder characterized by occlusion of the internal carotid arteries with cerebral angiographic finding of smoke-like collateral vessels. Typical moyamoya blush can also be seen in immediate enhanced CT scan of the brain. The disease is rare in non Japanese. The present communication reports four Thai children aged 3-12 years, presented at the Department of Pediatrics, Ramathibodi hospital with recurrent hemiparesis. In one patient, brain biopsy was almost carried out. The disease should be suspected in every child with recurrent cerebral ischemic episodes. Cerebral angiogram and immediate enhanced CT scan are the two most useful investigation procedures. Either of them should be selected first for diagnosis before other unnecessary invasive investigations are done.