Trans-sphenoidal encephalocele in association with Dandy-Walker complex and cardiovascular anomalies.

We present a case of trans-sphenoidal encephalomeningocele in association with a posterior cranial fossa malformation which fulfils the criteria for the Dandy-Walker complex [1]. Congenital cardiovascular defects were also present. An abnormality of neural crest development may be responsible for the combined occurrence of these anomalies.

Air-trapping in extrinsic allergic alveolitis on computed tomography.

AIM: To document the phenomenon and distribution of air-trapping on computed tomography in patients with sub-acute extrinsic allergic alveolitis (EAA). PATIENTS AND METHODS: A retrospective analysis of high resolution CT scans was performed on 20 patients with proven EAA. All patients had inspiratory scans and 12 patients had expiratory scans. These were assessed for the presence and distribution of: air-trapping, ground-glass opacification and nodularity. RESULTS: Areas of decreased attenuation consistent with small airways disease was demonstrated in 15/20 patients on inspiratory scans, and confirmed to be areas of air-trapping in 11/12 patients on expiratory scans. Additional areas of air-trapping were identified in 5/11 patients on expiratory scans. 18/20 patients had found-glass opacification and 14/20 patients demonstrated a nodular patter. CONCLUSION: Air-trapping is a common finding in sub-acute extrinsic allergic alveolitis on CT and its detection is enhanced by performing expiratory scans.

Fast CT for aortic dissection.

Results were evaluated in 81 patients with suspected acute aortic dissection who were examined on a fast CT system capable of a 1 s data acquisition time. 17 patients had Type A and nine had Type B dissections. Radiological assessment provided 78 confident reports and expressed some uncertainty about the diagnosis in three patients. Overall sensitivity for aortic dissection was 96.2% and specificity was 96.4%. When 78 confident reports alone were considered, both sensitivity and specificity reached 100%. Reconstruction of data at 100 ms intervals allowed discrimination between artefacts in the ascending aorta and Type A dissections. CT can often be used as the single investigation prior to surgery for acute Type A dissections.

The significance of low grade right iliac fossa uptake on 99Tcm-HMPAO labelled white cell scans.

Technetium-99m HMPAO labelled white cell scanning is now an accepted method for assessing the activity of inflammatory bowel disease. However, false positive results have been demonstrated. This study was conducted to assess the significance of low grade uptake on 99Tcm-HMPAO labelled white cell scans in the right iliac fossa (RIF) in the context of possible inflammatory bowel disease (IBD). 32 patients over a period of 1 year had low grade RIF uptake as the predominant abnormality. 20 of these had no prior diagnosis of inflammatory bowel disease. Only one case in this group was subsequently diagnosed as having Crohn's disease. Nodular lymphoid hyperplasia (NLHP) and non-steroidal anti-inflammatory drugs (NSAIDs) were also associated with low grade RIF uptake. Possible explanations for these findings are discussed.

Chest radiography guidelines for general practitioners: a practical approach.

An intensive programme of guideline development and dissemination is not always practical. We designed general practitioner guidelines for chest radiography and disseminated them to a group of 33 practices selected randomly from the practices that refer more than five patients for chest radiography annually. The subsequent 2500 requests were analysed and demographic data, the referring practice and the relevant history noted. We documented a reduction in the proportion of referrals that were contrary to the guidelines by 30.5% (from 8.2% to 5.7%, P = 0.016), a reduction in referral rate with an inadequate history by 29.7% (from 15.5% to 10.9%, P = 0.0008) and an increase in the frequency that a presumptive diagnosis was stated by 14.5% (from 42.9% to 49.1%, P = 0.0025). There was no overall reduction in referral rate in the study group and the reasons for this are discussed. We conclude that guidelines for chest radiography are effective in reducing inappropriate requests and can also improve the clinical information provided.