Progressing features of atypical mycobacterial infection in the lung on conventional and high resolution CT (HRCT) images.

PURPOSE: The aim of this study was to clarify the localization of abnormalities within secondary pulmonary lobules and the changes in follow-up studies of pulmonary atypical mycobacterial infection (AMI) by conventional and high-resolution computed tomography (HRCT). MATERIALS AND METHODS: Forty-six patients (16 men and 30 women; 43-84 years) with pulmonary AMI (M. intracellulare 36; M. avium 10) in the lung were examined by conventional and HRCT. RESULTS: In peripheral zones, all patients had the nodule located in the terminal or lobular bronchiole, and most of the patients also had nodules accompanied with a wedge-shaped or linear shadow connected with the pleura. In the follow-up scans, new centrilobular nodules appeared in other segments, and consolidation or ground-glass pattern appeared newly and was preceded by nodules. Bronchiectasis became more severe in five of 38 follow-up patients. CONCLUSION: The common HRCT findings of AMI were centrilobular, peribronchovascular nodules, bronchiectasis, consolidation, and pleural thickening/adhesion. The nodules frequently connected with the pleura. The initial and follow-up studies suggest that the disease may begin in the terminal bronchiole or as preexisting bronchiectasis and spread transbronchially along the draining bronchus or towards the pleura to produce lesions such as new nodules, cavities, consolidation, pleuritis, and bronchiectasis, or more severe bronchiectasis.

Altered flow dynamics of intravascular contrast material to the liver in superior vena cava syndrome: CT findings.

BACKGROUND: To evaluate the findings of altered flow dynamics in the livers of patients with obstruction of superior vena cava (SVC) on helical computed tomography (CT). METHODS: In six patients (age range = 28-80 years) with SVC obstruction, CT findings were retrospectively reviewed to identify the abnormal enhancement patterns of the liver and the relation with the extrahepatic collateral vessels and hepatic vessels. RESULTS: Abnormal hepatic enhancement was observed in the following four (A-D) portions: (A) anterior portion of segment IV (n = 5), (B) subdiaphragmatic portion of the liver (n = 4), (C) posterior portion of the right lobe (bare area; n = 1), and (D) lateral segment of the left lobe (n = 2). Two major collateral pathways to the liver were demonstrated as follows: A and D --> from the umbilical vein to the left portal vein, and B and C --> from the subcapsular vein to the bare area of the liver or to the hepatic veins. On helical CT, these collateral pathways were also clearly visualized. CONCLUSION: When these abnormal enhancements of the liver on CT are recognized within the liver, these findings indicate diversion of contrast material into collateral pathways to the liver with SVC obstruction.

Transcatheter adrenal arterial embolization of cortisol-producing tumors. Two cases of Cushing's syndrome.

Transcatheter arterial embolization (TAE) was performed in 2 patients with Cushing's syndrome caused by adrenal adenoma by using a mixture of absolute ethanol and iohexol. In 1 patient successful suppression of the hypersecretion of cortisol has continued for 9 months after TAE without complications. However, in the other patient, TAE was discontinued due to marked hypertension and tachycardia induced by a massive release of catecholamines from the embolized "normal" part of the tumor-bearing adrenal gland during the procedure. These results suggest that it is important to perform TAE of only the arterial branches feeding the tumor.

A case of asymptomatic giant myelolipoma of the adrenal gland.

A 50-year-old man had a giant myelolipoma of the right adrenal gland, 30 x 25 x 23 cm in size, and 3,500 g in weight. The mass was hyperechoic with low echoic areas in part on US, heterogeneous with fat density tissues and tissues with density higher than fat on enhanced CT, heterogeneous with fat intensity areas on both T1- and T2-weighted MR images and with other areas of low intensity on T1-weighted images and high intensity on T2-weighted images due to myeloid tissues, and relatively hypervascular on subphrenic arteriography. This tumor was unique because, except for palpation of the mass on physical examinations, there were no symptoms such as abdominal pain due to hemorrhage, necrosis, or pressure on the surrounding structures despite its huge size.

A case of chest wall Castleman's disease.

We describe the findings of a rare case of right anterior chest wall Castleman' s disease of the hyaline vascular type. It manifested as a solitary mass, 7.5 x 4.5 x 3.0 cm in size, with incomplete border and extrapleural signs on chest roentgenograms. The mass was hypoechoic with numerous tiny bright spots on US; it enhanced homogeneously on CT, had a homogeneously high intensity on both T1- and T2-weighted MR images, and showed rich vascularity with homogeneous capillary blush on internal thoracic arteriogram.