Retroperitoneal Lymphangiomyoma in a Patient with Pulmonary Lymphangiomyomatosis: Case Report

Retroperitoneal lymphangiomyoma is rare abdominal finding of lymphangiomyomatosis (LAM). We report here on a case of retroperitoneal lymphangiomyoma and this is the first case that? been seen in the Korean literature. Retroperitoneal lymphangiomyoma associated with pulmonary LAM has rarely been reported in radiologic literature. The charateristic findings of this case are a prominent solid component and retroperitoneal lymphadenopathy mimicking a malignant tumor. A 45-year-old woman was admitted for further evaluation of a lower abdominal mass that could be palpated for 2 weeks. US findings showed relatively well-defined mass with septated cystic portions and echogenic solid portions in the lower abdomen. CT findings revealed a well-demarked retroperitoneal mass with septated cystic portions and enhancing solid portions at the right lower abdomen, and there were multiple retroperitoneal lymphadenopathy at the lower abdomen. The patient underwent a mass excision. The pathologic findings were retroperitoneal lymphangiomyoma with multiple lymph node involvement.

Mediastinal and Hilar Lymphadenopathy: Cross-Referenced Anatomy on Axial and Coronal Images Displayed by Using Multi-detector row CT

The accurate evaluation of mediastinal and pulmonary hilar lymphadenopathy, especially in patients with lung cancer, is important for determining treatment options and evaluating the response to therapy. To indicate nodal location in detail, mediastinal and hilar lymph nodes have been assigned to one of 14 nodal stations. Mediastinal nodes of greater than 10 mm short-axis diameter are regarded as abnormal, irrespective of their nodal station, while hilar nodes are considered abnormal if their diameter is greater than 10 mm in any axis or they are convex compared to surrounding lung. By providing multiplanar images, multi-detector row CT allows detailed evaluation of thoracic anatomic structures more easily than in the past, when axial images only were available. At cross-referenced imaging, a lymph node depicted at axial imaging in one anatomical location can be visualized simultaneously and automatically at coronal imaging at the exactly corresponding anatomical location. Cross-referenced coincidental axial and coronal images help assess both the size and morphology of mediastinal and hilar lymph nodes.

Imaging Findings of Castleman's Disease Localized in the Axilla: A Case Report

Castleman's disease is a rare benign lymphoproliferative disorder of uncertain origin which most commonly involves the mediastinum but rarely affects the axilla. We report a case of localized Castleman's disease involving the axillary lymph node. Mammography revealed a well-defined, homogeneously dense ovoid mass, 3 cm in size, in the left axilla, while gray-scale ultrasonography (US) demonstrated a well-defined, uniformly hypoechoic ovoid mass with good through transmission. Peripheral hypervascularity was observed at power Dopper US, and early rapid homogeneous enhancement at contrast-enhanced dynamic CT.

Lymph Node Metastases in Thyroid Carcinomas: CT Diagnosis

PURPOSE: To determine the usefulness of CT for diagnosing metastases to primary and secondary echelon lymph nodes (LNs) and to investigate various CT findings of metastatic LNs in thyroid carcinomas. MATERIALS AND METHODS: We retrospectively reviewed the CT and histologic findings in 59 patients with thyroid carcinomas who had undergone thyroidectomy and neck dissection. Primary echelon LNs (Level VI) were removed by central neck dissection in all patients, and in 21, a total of 136 levels of secondary echelon LNs (Level II-V) were excised away by lateral neck dissection. CT criteria of metastatic LNs included large size, significant homogeneous enhancement, calcification, and cystic change. We evaluated the ability of CT to detect primary and secondary echelon LN metastasis and tried to determine which CT features were useful for the diagnosis of LN metastasis. RESULTS: Histologically, LN metastasis was found in 31 (53%) of 59 patients, including 30 with metastasis to primary echelon LNs. Of the 136 levels of secondary echelon LNs resected in 21 patients, 44 were found at histology to harbor metastatic foci. The sensitivities, specificities, positive and negative predictive values, and accuracies of CT in the diagnosis of metastasis to primary and secondary echelon LNs, respectively, were 27% and 93%, 100% and 93%, 100% and 87%, 57% and 97%, and 63% and 93%. While all secondary echelon LNs with at least one of the following CT criteria-large size (n=19), cystic or necrotic change (n=14), or calcifications (n=8)-were histologically proven to be metastatic, six (24%) of 25 such LNs with a sole sign of significant enhancement at CT were found to be due to reactive lymphadenopathy. CONCLUSION: Although CT was unable to detect metastasis to primary echelon LNs, it was useful in the detection of secondary echelon LN involvement. Large size, cystic change, and calcification are considered highly reliable signs of metastatic LNs.

CT Findings of Kikuchi Disease: Correlation with Pathologic Findings

PURPOSE: To evaluate by means of retrospective analysis of neck CT scans the CT findings which suggest kikuchi disease. MATERIALS AND METHODS: The authors evaluated the CT findings of seven cases of Kikuchi disease histologically confirmed by excisional biopsy. Four males and three females aged between 12 and 43 (mean; 28) years were included. The authors retrospectively analyzed distribution, bilaterality, the presence of aggregation, the presence of intranodal low density after contrast enhancement, the number, size, shape and location of areas of intranodal low density, and the presence of extracapsular extension in involved nodes, as seen on pre- and post-contrast CT scans. Attempts were then made to correlate the CT with the pathologic findings. RESULTS: The range of conditions affecting patients included palpable(7/7) and tender (6/7) nodes, fever(5/7), night sweat(2/7), leukopenia(2/7), and weight loss(1/7). The internal jugular and spinal accessory chains were involved in all seven cases, followed by the submandibular(6/7), submental(5/7), supraclavicular(1/7) and axillary( 1/7) nodes. The findings observed also included bilateral involvement of the internal jugular chain(6/7), the spinal accessory chain(5/7), and the submandibular(4/6) and supraclavicular nodes(1/1). CT revealed that in all cases, pathologic lymph nodes showed aggregation in one or several nodal groups, namely a mixed homogeneous( mean, 60%) or inhomogeneous(mean, 40%) enhancement pattern; intranodal low densities with the number(1 -7), size(1 -7mm) and shape(oval, round, or elongated) of varying degree and predominantly ( 92%) peripheral location, and extracapsular extension. CONCLUSION: The CT findings which suggest Kikuchi disease in cervical lymphadenopathy were (1) involvement varying from no intranodal low density to prominent intranodal low densities; (2) intranodal low densities, with the number, size and shape of varying degree and predominantly peripheral location, which were correlated with pathologic findings, including variable intranodal areas of necrosis areas in mainly cortical and paracortical regions of nodes.