Lung cancer detection with low-dose spiral computed tomography in chronic obstructive pulmonary disease patients.

PURPOSE: To determine whether low-dose spiral computed tomography (LDCT) can improve the lung cancer detection rate in chronic obstructive pulmonary disease (COPD) subjects. MATERIAL AND METHODS: From October 1999 to December 2003, 374 COPD patients underwent LDCT for lung carcinoma screening. All subjects with an abnormal baseline CT scan were followed with serial CT scans as part of our protocol. Follow-up was continued until the demonstration of no change over a minimum of 24 months, or resolution. Sputum samples were also obtained for cytological analysis. RESULTS: On the baseline spiral CT scan, 132 of 374 patients (35.2%) had at least one non-calcified nodule that required periodic follow-up with CT scans. The median follow-up time was 21 months (range 2-48 months). Of the 374 COPD subjects, nine patients with primary lung cancer (2.4%) were detected: six were squamous cell carcinomas, two were small-cell lung carcinomas (SCLC), and one was adenosquamous carcinoma. Three of the nine tumors were in stage IA, two in stage IIB, two in stage IIIA, and two were limited SCLC. Potentially curative pulmonary resection was performed in four patients, pulmonary lobectomy in three, and wedge excision in one. One subject with stage IA squamous cell carcinoma received radiotherapy, as pulmonary function was severely impaired. In addition, four patients underwent removal of benign lesions. Sputum was collected in 205 (54.8%) of 374 patients. There were 154 (75 %) metaplasia, 14 (6%) moderate dysplasia, and one (0.4%) malignant case. CONCLUSION: LDCT increases early lung carcinoma detection rate in COPD patients, but pulmonary function impairment may reduce its benefit.

Vertebral pneumatocysts.

OBJECTIVE: To review the prevalence and location of vertebral pneumatocysts and evaluate the CT findings of these benign lesions. MATERIAL AND METHODS: Retrospectively we reviewed CT images of 89 patients with suspected disc disease during a 6-month period. RESULTS: Distinctive CT pattern of intraosseous pneumatocysts involving the cervical, thoracic and lumbar spine was found. In 8 patients (9%), 10 vertebral pneumatocysts were detected. Five were located in the vertebral body and 4 of these were associated with vacuum phenomenon in adjacent intervertebral discs. Five were located near the facet joint and all were associated with vacuum phenomenon in adjacent facet joint. CONCLUSION: Intraosseous pneumatocyst is a benign lesion, therefore biopsy and follow-up are unnecessary. Although vertebral pneumatocysts seem to be uncommon with a few reported cases, this study shows them to be more frequent than previously thought.

Anteroposterior diameter of the vertebral canal in cervical region: comparison of anatomical, computed tomographic, and plain film measurements.

The purpose was to compare the computed tomographic and plain film measurements with those of anatomical specimens to determine the antero-posterior diameter of the spinal canal in cervical region. Antero-posterior diameters of 75 cervical vertebral canals (15 sets of C3-C7) were measured anatomically at two different levels. Computed tomographic and plain film measurements were also obtained at the corresponding levels. Considering anatomical measurements as the gold standard, plain film and computed tomographic measurements were statistically compared. Interobserver and intraobserver differences were also evaluated. At the uppermost pedicle levels, there was no statistically significant difference between plain films and anatomical measurements, a good correlation. However, at lowermost pedicle level there was a statistically significant difference between plain films and anatomical measurements but not between tomographic and anatomical measurements. Our results suggest that plain films can accurately estimate cervical spinal canal mid-sagittal diameter at the uppermost pedicle level and be used as a first step examination for the evaluation of cervical spinal stenoses.

Intrapulmonary right brachiocephalic vein associated with azygos lobe.

A rare case of right brachiocephalic vein (RBV) following an extramediastinal and intrapulmonary course in the anterior portion of the azygos fissure is presented. The appearance of the RBV and superior vena cava (SVC) on the chest radiograph in patients with an azygos lobe reflects the variable relationship between these veins and their mediastinal attachments. Computed tomography (CT) can easily demonstrate the mediastinal vascular anatomy thereby allowing identification of such variants and differentiation from anomalous pulmonary veins draining into the systemic vein.

Schwachman-Diamond syndrome. A case report.

Schwachman-Diamond syndrome is an autosomal recessive disorder consisting of exocrine pancreatic insufficiency and neutropenia. The typical pathological finding with this syndrome is fatty infiltration in the pancreas of patients. We report a case of Scwachman-Diamond syndrome examined with abdominal ultrasonography, CT and radiography.

Absence of the azygos vein.

A rare case of the absence of the azygos vein (AV) is presented. Imaging findings on plain chest film and on contrast-enhanced spiral computed tomography (CT) are described, and embryology of azygos and hemiazygos veins (HV) is reviewed. On PA chest radiographs, both the absence of AV shadow on its usual location and the presence of the aortic nipple may consider agenesis of AV, and this anomaly can be easily confirmed by CT.

Absence of the azygos vein associated with double superior vena cava--a case report.

A rare case of absence of the azygos vein associated with double superior vena cava is presented. Imaging findings on plain chest film and on contrast-enhanced computed tomography are described, and the embryology of azygos and hemiazygos veins is reviewed.

Multidrug resistant malignant melanoma with intracranial metastasis responding to immunotherapy.

Metastatic malignant melanoma (MM) is well known for its poor response to chemotherapy, radiotherapy, and its remarkable susceptibility to interleukin-2 (IL-2) based immunotherapies. MM with brain metastatis in particular, has 4-5 months life expectancy from metastasis to death. Drug efflux pumps such as P-glycoprotein (P-gp), or drug detoxifying mechanisms e.g. glutathion epsilon S-transferase-pi (GST) are some of the possible multidrug resistance (MDR) mechanisms in MM. Here we report the first P-gp+ MDR MM with brain metastasis in the literature, demonstrating a remarkable response to IL-2, interferon-alpha (IFN), 5-fluorouracil (5FU) regimen. A 41-year old man was admitted with multiple inoperable brain lesions. Biopsies from intracranial and dermal lesions revealed MM. Cisplatin, carmustine, dacarbazine, tamoxifen (CCDT) together with external cranial radiotherapy were administered, and partial response in lesions and symptoms was achieved. However, after the third course of CCDT treatment, he was admitted to the emergency ward with dramatically increased intracranial lesions, and recurring dermal lesions. A biopsy from the recurred lesions revealed that MM cells were P-gp+, but GST. Administration of a IL-2, IFN and 5FU regimen achieved a remarkable decline in the brain lesions with almost total disappearance of symptoms. He was well and capable of doing work for 18 months. Dermal lesions had not recurred since the beginning of immunotherapy. In contrast, another 34-year old man who developed brain metastases after CCDT for MM, was negative for P-gp and GST. Cranial radiotherapy was started and the above mentioned IL-2 based regimen was administered. However, no response was observed. These two cases together with previous studies demonstrating the susceptibility of P-gp+ MDR cancer cell lines to IL-2 activated killer (LAK) cells in this report suggest that P-gp+ MDR MM is probably a good candidate for IL-2 based treatments.

Central diabetes insipitus in a patient with congenital toxoplasmosis.

A 33-day-old male infant who developed central diabetes insipitus as a complication of congenital toxoplasmosis is presented. He had polyuria and hypernatremia on admission and responded to Intranasal desmopressin acetate with the normalization of above mentioned findings. Computed tomographic (CT) scan of the brain showed obstructive hydrocephaly with periventricular and right basal ganglion calcification. CT scan of the pituitary gland, thyroid function tests, and serum cortisol levels were all normal. This is the first report of isolated diabetes insipitus with congenital toxoplasmosis in literature and central diabetes insipitus should be remembered if polyuria and hypernatremia develops in a patient with congenital toxoplasmosis.

Renal colic: comparison of spiral CT, US and IVU in the detection of ureteral calculi.

The aim of our study was to compare non-contrast spiral CT, US and intravenous urography (IVU) in the evaluation of patients with renal colic for the diagnosis of ureteral calculi. During a period of 17 months, 112 patients with renal colic were examined with spiral CT, US and IVU. Fifteen patients were lost to follow-up and excluded. The remaining 97 patients were defined to be either true positive or negative for ureterolithiasis based on the follow-up data. Sensitivity, specificity, positive and negative predictive value and accuracy of spiral CT, US and IVU were determined, and secondary signs of ureteral stones and other pathologies causing renal colic detected with these modalities were noted. Of 97 patients, 64 were confirmed to have ureteral calculi based on stone recovery or urological interventions. Thirty-three patients were proved not to have ureteral calculi based on failure to recover a stone and diagnoses unrelated to ureterolithiasis. Spiral CT was found to be the best modality for depicting ureteral stones with a sensitivity of 94 % and a specificity of 97 %. For US and IVU, these figures were 19, 97, 52, and 94 %, respectively. Spiral CT is superior to US and IVU in the demonstration of ureteral calculi in patients with renal colic, but because of its high cost, higher radiation dose and high workload, it should be reserved for cases where US and IVU do not show the cause of symptoms.

A case of thoraco-omphalo-ischiopagus bipus conjoined twins.

A case of thoraco-omphalo-ischiopagus bipus conjoined twins is reported. The twins shared a common lower chest and abdominal wall, a single pelvis and two lower extremities. Our initial approach was to determine the detailed anatomy of the viscera and then to outline a surgical plan. However, the twins' general condition gradually deteriorated, and the approach was not completely realized despite maximal supportive therapy for cardiorespiratory failure. After the death of the twins, it was detected that they had a single pericardial cavity, and shared an abdominal aorta and vena cava. Furthermore the right twin had Bochdalek hernia and left ventricular hypoplasia. Consequently, such cardiovascular pathologies, coupled with major additional anomalies, may threaten the twins' life. Therefore further management plans are required considering urgent surgical correction of the life-threatening anomalies before the definitive procedure.

A case of intrapulmonary teratoma presenting with hair expectoration.

Benign cystic teratomas of the lung are extremely rare. Up to the present time, around 30 cases have been reported in the literature. We report an additional case, a 28-year-old woman, admitted with the complaint of expectoration of hair. Histopathological, clinical, and Ct features are presented.

Scapulothoracic dissociation: a case report.

Scapulothoracic dissociation has been described as a "closed traumatic forequarter amputation" and is characterized by massive soft tissue swelling of the shoulder, lateral displacement of the scapula, neurovascular injuries (brachial plexus, subclavian artery), an osseous-ligamentous injuries. In addition to the lateral displacement of the scapula, an acromioclavicular separation, a displaced fracture of the clavicle or sternoclavicular separation can be identified on plain X-rays. This injury pattern has been infrequently reported. We present a patient who had a previously unreported combination of roentgenographic findings, and in whom the diagnosis was revealed by computed tomographic evaluation.

Percutaneous sclerotherapy of a symptomatic simple renal cyst in a child: observation of membrane detachment sign.

A 6-year-old girl with a symptomatic renal cyst underwent successful percutaneous aspiration and sclerotherapy with hypertonic saline under US guidance. Although membrane detachment sign was seen clearly during aspiration, it was confirmed to be a simple cyst. In contrast to previous reports, membrane detachment sign is not pathognomonic for hydatid cysts and may be seen after simple cyst aspiration. Therefore, differentiation of a symptomatic renal cyst from a hydatid cyst should not depend solely on membrane detachment sign. In either case US- or CT-guided percutaneous sclerotherapy should always be considered before surgery.