Phaeochromocytoma of the urinary bladder localized by selective venous sampling and computed tomography.

Clinical and biochemical evidence of a catecholamine-secreting tumour was documented in a 19-year-old female presenting with malignant hypertension. The tumour was successfully localized to the pelvis by means of plasma noradrenaline assay from multiple sites, after previous attempts at localization had failed. Subsequently, computed tomographic (CT) scan allowed correct pre-operative localization to the urinary bladder.

Computed tomography of fatty infiltration of the liver.

Fatty infiltration of the liver can be identified by means of and may have a spectacular appearance on computed tomography (CT). Fifteen cases are described and the clinical associations are discussed. CT may be useful as a primary technique for the diagnosis of a fatty liver when performance of a biopsy is contraindicated.

Cerebral cysticercosis with reference to the natural history of parenchymal lesions.

The cerebral parenchymal response to degeneration of cysticerci was studied in 83 consecutive patients investigated over 5 1/2 years. Virtually all came from an endemic region of South Africa and 67% were children. Occasionally, computed tomography (CT) delineated an inert shower of cysticerci. The humoral and tissue reactions resulting from larval death cause intense cerebral edema and granulomata, which manifest particularly in the pediatric age group. Local and diffuse cerebral edema has not been stressed before nor has its incidence been evaluated. The shortest interval between cysticercal degeneration and its granulomatous response to the final radiographic calcification was found to be 25 months.

Computed tomographic and ultrasonic localization of adrenal mass lesions.

A study of 20 patients with adrenal mass lesions shown on computed tomography (CT) is reported. CT accurately localized a unilateral adrenal mass in 12 patients with Cushing's syndrome, primary hyperaldosteronism and phaeochromocytoma. Unsuspected primary or metastatic neoplasms of the adrenal glands were detected in 8 patients who underwent CT for other reasons. In 9 cases ultrasonography was also useful in localizing large adrenal masses. This study confirms the safety and accuracy of CT and ultrasonography in evaluating patients with adrenal masses, thereby obviating the need for more invasive diagnostic procedures.

Selenium-75-cholesterol imaging and computed tomography of the adrenal glands in differentiating the cause of Cushing's syndrome.

Measurement of 75Se-cholesterol (Scintadren) uptake and computed tomography (CT) of the adrenal glands were compared as a means of differentiating the cause of Cushing's syndrome in 11 patients over a 2-year period. Quantitative Scintadren imaging differentiated adrenocorticotrophic hormone (ACTH)-dependent disease from local adrenocortical lesions as the cause of Cushing's syndrome in all the patients studied. CT of the adrenal glands rapidly and accurately detected the adrenal mass lesions in 2 cases and was effective in documenting bilateral hyperplasia due to ectopic ACTH-dependent disease. However, in entopic ACTH (pituitary)-dependent disease the adrenal glands were of normal thickness in all but 2 patients, who had bilateral hyperplasia. Scintadren imaging and CT are useful non-invasive procedures for differentiating local adrenal disease from ACTH-dependent disease as the cause of Cushing's syndrome and should be the initial investigations once a firm clinical and biochemical diagnosis of Cushing's syndrome has been made.

Paediatric abdominal computed tomography: the technique and use in neuroblastomas and pelvic masses.

Paediatric abdominal CT often has to be performed outside a children's hospital. Without careful planning, the examination can be unrewarding and full of snags, and our technique for these conditions is outlined. Some of the problems of whole body CT are discussed and the examination has been found to be of the greatest value in children with extensive retroperitoneal and pelvic masses. In these circumstances it may be used for both diagnosis and treatment follow-up, and the benefits it provides justify any increased radiation to the patient.

Cholecystitis in an intrahepatic gallbladder. A case report.

A case of cholecystitis in an intrahepatic gallbladder with concurrent choledocholithiasis is reported. The patient initially presented with pyrexia of unknown origin and subsequently with suppurative cholangitis; the diagnosis was resolved pre-operatively using contemporary techniques of gallbladder delineation. Simple drainage of the gallbladder with choledocholithotomy proved effective.

Quantitative selenium-75-cholesterol imaging and computed tomography of the adrenal glands in Conn's syndrome.

Six consecutive patients with biochemically proven primary aldosteronism (4 with unilateral aldosteronomas and 2 with bilateral hyperplasia) underwent imaging with 75Se-selenomethyl-nor-cholesterol (Scintadren; Radiochemical Centre, Amersham, UK) and computed tomography (CT) of the adrenal glands to aid in lateralizing unilateral aldosterone-producing adenomas (APA) and to differentiate APA from idiopathic adrenal hyperplasia (IAH). Scintadren quantitative imaging alone was successful in lateralizing the lesion in all 4 cases of unilateral APA; mean uptake by the affected adrenal gland was 0.47% of the administered dose as against 0.23% in the normal gland (P less than 0.01). The mean uptake ratio for the adenomatous as against the normal gland was 2.03 (range 1.75-2.21), which was significantly greater than the uptake ratio of 0.82 in 4 normal individuals (P less than 0.01). CT lateralized all the APAs. In the 2 cases of IAH, Scintadren uptake was bilaterally increased in one case in which CT was normal, whereas in the other case Scintadren uptakes were normal while CT showed two abnormal glands. The overall diagnostic yield for Scintadren was 83%; the figure for CT was also 83%. When the results of Scintadren imaging and CT are pooled, the accuracy in lateralizing APAs and differentiating APA from IAH as a cause of Conn's syndrome is 100%.

Computed tomography (CT) in parenchymatous cerebral cysticercosis.

Cysticercosis is an infection with a larval or a bladder-worm stage of the species of Taenia. Cysticerci have a predeliction for the nervous system where they may be found in the meninges, the ventricles and within the brain itself. Brain involvement or parenchymatous form has an acute and chronic phase. Before the advent of CT scanning radiology was of little value in the acute parenchymatous cysticercosis, but with CT the changes within the brain can be recognised. In reviewing 14 cases of acute parenchymatous cysticercosis three CT patterns were found. 1. A diffuse low density pattern with no or little change after contrast medium 2. Multiple low densities with small rounded central areas of enhancement. 3. Large cystic lesions which may become ring lesions after contrast medium. We conclude that in an endemic area for cysticercosis, when one of these CT patterns is present, cysticercosis should be considered in the differential diagnosis. In a child where the clinical features are suggestive, the CT pattern may be diagnostic of cysticercosis. In the chronic parenchymatous stage the cysts have calcified and this may occur within one year of the acute onset. In 11 cases of chronic parenchymatous cysticercosis where the calcification was visible on the plain skull radiographs the CT scan added very little additional information. It may however be of value in confirming intracranial calcifications where their presence on the plain skull radiograph is in doubt.

Computed tomography of infratentorial masses in children.

Seventeen cases of infratentorial mass lesions (excluding abscesses) in children are reviewed. The findings after computed axial tomography (CAT) are described, as well as the changes that were revealed by plain radiographs of the skull. Ancillary investigations were performed in 11 cases, and their usefulness is assessed. The possibility of making a provisional diagnosis of the nature of the lesion based on CAT findings is discussed.