Aberrant cervical thymus in an infant: an unusual cause of stridor

We report an 8-month-old infant presenting with stridor caused by a nonpalpable neck mass discovered at imaging and surgery. The diagnosis of aberrant thymic tissue was confirmed at histopathology. The authors reviewed the literature and discuss the embryology, imaging findings and differential diagnosis of this rare disorder. Received: 1 July 1999; Revised: 3 September 1999; Accepted: 6 September 1999     

Helical CT: a useful technique in the evaluation of aortic intramural hematoma

Purpose: To investigate the diagnostic role of helical CT in aortic intramural hematoma. Material and methods: We retrospectively evaluated CT images obtained during a 6-year period, between 1994 and 2000, in 427 patients who underwent helical CT. Only 21 patients had typical findings of aortic intramural hematoma. All studies were performed with helical technique before and after a power injection of nonionic contrast material. Results: Twenty-one patients had aortic wall thickening (9 type A and 12 type B in Stanford's classification). Wall thickening was more than 4 mm in all cases, it was irregular in shape in 16/21 patients (76 %) and had a regular concentric shape in the remaining 5/21 patients (24 %). One patient with type A hematoma died soon after CT diagnosis because of arrhythmia caused by hemopericardium. Five patients (4 type B and one type A) underwent pharmacological therapy and radiological follow-up. Fifteen patients (7 type A and 8 type B) underwent prosthetic surgery and six of these died of postoperative complications. Conclusion: Helical CT represents the first step in the early diagnosis of aortic intramural hematoma before complications develop. In our experience, which agrees with the reports of other authors, helical CT is an accurate and valuable investigation for identifying the location and extent of an aortic intramural hematoma.     

Functional imaging of the thoracic outlet syndrome in an open MR scanner

Symptoms due to thoracic outlet syndrome may present only in abduction, a position that cannot be investigated in conventional MR scanners. Therefore, this study was initiated to test MRI in an open magnet as a method for diagnosis of thoracic outlet syndrome. Ten volunteers and 7 patients with a clinical suspicion of thoracic outlet syndrome were investigated at 0.5 T in an open MR scanner. Sagittal 3D SPGR acquisitions were made in 0 and 90 ° abduction. In the patients, a similar data set was also obtained in maximal abduction. To assess compression, the minimum distance between the first rib and the clavicle, measured in a sagittal plane, was determined. In the neutral position, no significant difference was found between patients and controls. In 90 ° abduction, the patients had significantly smaller distance between rib and clavicle than the controls (14 vs 29 mm; p < 0.01). On coronal reformatted images, the compression of the brachial plexus could often be visualised in abduction. Functional MR examination seems to be a useful diagnostic tool in thoracic outlet syndrome. Examination in abduction, which is feasible in an open scanner, is essential for the diagnosis. Received: 22 February 1999; Revised: 15 June 1999; Accepted: 30 June 1999     

Congenital absence of the horizontal portion of the left portal vein: ultrasound findings

Congenital absence of the horizontal portion of the left portal vein is very rare and has been very reported sporadically. We present three such cases referred from other hospitals with a diagnosis of intrahepatic vascular anomaly. Color Doppler ultrasound not only confirmed the diagnosis but also allowed a quantitative measurement of blood flow in these cases. Although it is a very rare condition, knowledge of the ultrasound and color Doppler findings helps in establishing the diagnosis of this congenital anomaly. Received: 9 July 1999; Revised: 25 October 1999; Accepted: 25 October 1999     

Asymptomatic aneurysm of the proximal right subclavian artery: a rare ultrasound diagnosis

True aneurysms of otherwise normal subclavian arteries are uncommon peripheral vascular anomalies. Most patients with subclavian artery aneurysms are symptomatic by presenting neurologic signs. We report a young woman who had an asymptomatic true aneurysm of the right subclavian artery assumed to be of congenital origin. This case is unique in that the aneurysm was in the extremely rare anatomic location of the right supraclavicular fossa between the origins of the right subclavian artery and the vertebral artery. Aneurysms of the right subclavian artery may represent a potential pitfall in conventional gray-scale ultrasound of the neck particularly the supraclavicular fossa. Differential diagnosis includes cervical cyst, pharyngo-esophageal diverticulum, vascular anomalies, struma, enlarged lymph node, as well benign or malignant neoplasms. Color duplex ultrasound should be performed as the method of choice for further analysis of suspected aneurysms. In this report the role of B-mode ultrasound and color duplex ultrasound is discussed in relation to digital subtraction- and MR angiography in confirmation of the diagnosis. Received: 5 January 1999; Revision received: 26 April 1999; Accepted: 18 June 1999     

Follow-up of patients with previous treatment for coarctation of the thoracic aorta: comparison between contrast-enhanced MR angiography and fast spin-echo MR imaging

Regular follow-up is required in patients with previous intervention for coarctation of the aorta to detect recoarctation or aneurysm formation. In this study we describe the findings encountered on routine follow-up exams and we compare the use of contrast-enhanced 3D MR angiography (CE MRA) with fast spin-echo MRI (FSE) to study the thoracic aorta after previous intervention. In 51 consecutive patients previously treated for aortic coarctation, 74 MR studies of the thoracic aorta were performed during a 2-year period using CE MRA and FSE MRI. The thoracic aorta was evaluated for abnormalities of course, caliber, shape, and pathology of side branches. The CE MRA and FSE MRI studies were evaluated side by side by consensus of two reviewers evaluating which MR technique depicted the abnormalities of the thoracic aorta the best. Of 74 exams, six clinically important abnormalities were found: four aneurysms and two restenoses. Two small pseudoaneurysms were missed on the FSE studies. Contrast-enhanced MRA was judged to visualize aortic abnormalities better than FSE (47 of 74 MR studies) especially for the transverse aortic arch, coarctation site, left subclavian artery, and aortic arch configuration. For the ascending aorta and distal descending aorta, CE MRA and FSE performed equally well. Aortic diameters measured at four levels in the first 18 MRI studies showed no significant differences in diameter when measured by FSE or CE MRA (p = not significant). Clinically important abnormalities, such as aneurysm formation and restenosis, can be present years after treatment for aortic coarctation. In the regular follow-up of these patients, CE MRA may provide additional diagnostic information compared with FSE and should be included as part of the routine exam. Received: 3 April 2000; Revised: 5 July 2000; Accepted: 7 July 2000     

Optic nerve aspergillosis: report of a case diagnosed by fine-needle aspiration biopsy

The aim of this study was to describe the fine-needle aspiration biopsy (FNAB) procedure in patient with a optic nerve lesion. A case of optic nerve and brain aspergillosis, an infrequent condition that can mimic tumor or tumor-like lesions, is reported. The patient was studied by CT and MRI and definite diagnosis was established by means of an ultrasound-guided FNAB. Specimen preparation revealed the presence of multiple hyphae of Aspergillus fumigatus in the optic nerve lesion. The FNAB procedure is a safe and reliable diagnostic method for suspected intraorbitary tumors and tumor-like conditions especially when other less-invasive modalities have failed to establish the diagnosis and when cytologic confirmation is needed to implement aggressive therapy. Received: 18 March 1999; Revised: 22 July 1999; Accepted: 28 July 1999     

Hypoplasia of the internal carotid artery: a noninvasive diagnosis

We present the characteristic imaging findings of hypoplasia of the internal carotid artery (ICA) in two cases, one accompanied by an intracranial aneurysm. Finding of a diffuse luminal narrowing of the ICA on MR angiography or digital subtraction angiography (DSA) could wrongly evoke severe acquired diseases such as dissection or atherosclerosis. Absence of associated wall thickening and flow disturbances on color Doppler sonography (CDS) should suggest carotid hypoplasia. Confirmation of the diagnosis is obtained by CT of the skull showing a small carotid canal. Non-invasive procedures are sufficient to differentiate this rare congenital anomaly from acquired string signs. Received: 25 October 1999; Revised: 27 January 2000; Accepted: 30 March 2000     

Imaging of blunt chest trauma

In western European countries most blunt chest traumas are associated with motor vehicle and sport-related accidents. In Switzerland, 39 of 10,000 inhabitants were involved and severely injured in road accidents in 1998. Fifty two percent of them suffered from blunt chest trauma. According to the Swiss Federal Office of Statistics, traumas represented in men the fourth major cause of death (4 %) after cardiovascular disease (38 %), cancer (28 %), and respiratory disease (7 %) in 1998. The outcome of chest trauma patients is determined mainly by the severity of the lesions, the prompt appropriate treatment delivered on the scene of the accident, the time needed to transport the patient to a trauma center, and the immediate recognition of the lesions by a trained emergency team. Other determining factors include age as well as coexisting cardiac, pulmonary, and renal diseases. Our purpose was to review the wide spectrum of pathologies related to blunt chest trauma involving the chest wall, pleura, lungs, trachea and bronchi, aorta, aortic arch vessels, and diaphragm. A particular focus on the diagnostic impact of CT is demonstrated. Received: 29 November 1999; Accepted: 28 January 2000     

Ruptured adrenal artery aneurysm: a case report

A case of ruptured adrenal artery aneurysm is presented. The ultrasound, computed tomography and selective renal angiography findings are described in detail. Aneurysms of adrenal arteries are particularly rare. Early diagnosis is important because of their tendency towards rupture and subsequent high mortality rate. Received: 12 November 1998; Revised: 10 March 1999; Accepted: 13 April 1999     

Solitary myofibromatosis of the skull

We present a case of solitary infantile myofibromatosis of the skull in a 3-month-old boy. A right parietal subcutaneous lump was found at birth, and it increased in size over the ensuing 3 months. Surgery was performed, and a diagnosis of myofibromatosis was confirmed histopathologically. Solitary myofibromatosis of the skull is extremely rare. The radiographical, CT, and MR appearances, as well as histopathological findings, are described in this article. Received: 30 December 1998; Revised: 21 April 1999; Accepted: 11 May 1999     

A longitudinal insufficiency fracture of the tibia in association with a healed chronic osteomyelitis

Longitudinal stress fracture of the tibia often present with an atypical clinical presentation which can be mistaken for osseous tumor or osteomyelitis. We present a case of longitudinal stress fracture of the tibia which occurred in a patient with healed chronic osteomyelitis of the tibia. Magnetic resonance imaging failed to make the correct diagnosis. Accurate diagnosis was only obtained by helical CT which showed the longitudinal fracture line. Magnetic resonance imaging showed only non-specific signs of bone marrow edema, suggesting recurrence of osteomyelitis. Magnetic resonance imaging can be misleading in the absence of direct visualization of the fracture line. Received: 30 September 1999; Revised: 26 April 2000; Accepted: 2 May 2000     

Mammary tuberculosis: percutaneous treatment of a mammary tuberculous abscess

It is currently very rare to find mammary involvement in cases of tuberculosis, in either primary or secondary form. Diagnosis is classically clinical and microbiological, and the basic techniques used in imaging diagnosis are mammography and ultrasound. Computed tomography may define the involvement of the thoracic wall in those cases which present as mammary masses adhering to deep levels, and is also able to evaluate accompanying pulmonary disease, if it is present. Traditionally, treatment has consisted of quadrantectomy and specific antibiotic therapy. We present a case of tuberculous mammary abscess secondary to pulmonary disease, which was treated by percutaneous drainage controlled by CT and specific antibiotic therapy. We revise the diagnosis, differential diagnosis and treatment of mammary tuberculosis. Received: 27 July 1998; Revision received: 2 February 1999; Accepted: 20 April 1999     

Cystic dysplasia of the testis: a rare cause of painless hemiscrotal enlargement in childhood

Cystic dysplasia of the testis is a rare, benign cause of painless hemiscrotal enlargement in children. We present two cases of cystic dysplasia of the testis presenting with scrotal enlargement. The diagnosis was based on its specific sonographic findings and on the coexistence of a multicystic dysplastic kidney in one case. Received: 2 December 1999; Revised: 23 March 2000; Accepted: 27 March 2000     

Meningeal hemangiopericytoma in childhood

Meningeal hemangiopericytoma (MHP) is extremely rare in childhood. Mean age at diagnosis is between 38 and 43 years. We present an 8-year-old boy with MHP of the middle cranial fossa. Imaging findings were indistinguishable from an aggressive bone tumor such as Ewing's sarcoma. Imaging findings are presented and discussed. Our case indicates that MHP should be considered in the differential diagnosis of skull-base tumors despite the fact that MHP is extremely rare in childhood. Received: 8 July 1999; Revised: 28 September 1999; Accepted: 29 September 1999     

Intraventricular mass lesions of the brain

Intraventricular tumours represent a diverse group of lesions, some of them infrequent, with a wide variety of radiological features. Determination of their precise aetiology or origin can be difficult. Nevertheless, considering patient's age, location within the ventricles, and some specific radiological features, the radiologist should be able to narrow down the differential diagnosis. This paper reviews the characteristic radiological appearances of the diverse intraventricular lesions emphasising its differential diagnosis. Received: 6 July 1999; Revised: 5 August 1999; Accepted: 9 August 1999     

Various radiological appearances of angiomyolipoinas in the same kidney

A 21-year-old woman with tuberous sclerosis presented with abdominal distension and flank pain. Imaging studies, including CT and MR imaging, revealed bilateral renal mass lesions, containing fat and suggesting the diagnosis of tuberous sclerosis. However the imaging characteristics of one of these lesions differed from the others with no radiologically detectable fat tissue in this solid lesion suggesting renal cell carcinoma. Histopathological examination of this lesion in the left kidney revealed an angiomyolipoma with minimal fat tissue. The radiological diagnosis of angiomyolipomas with minimal fat tissue remains difficult and the differential diagnosis is discussed. Received: 5 October 1998; Revised: 22 December 1998; Accepted: 7 June 1999     

Imaging of diffuse esophageal leiomyomatosis: two case reports and review of the literature

Diffuse esophageal leiomyomatosis is a rare disorder which may be found in association with leiomyomas in other locations or with other disorders. We report two cases in men, one with associated tracheobronchial involvement, which illustrate the value of imaging in differentiating this entity from other causes of dysphagia and in establishing a diagnosis. Received: 24 December 1998; Revised: 10 May 1999; Accepted: 10 May 1999     

Image-guided automated needle biopsy of 106 thoracic lesions: a retrospective review of diagnostic accuracy and complication rates

We reviewed the diagnostic accuracy and complication rates of transthoracic needle biopsy (TNB) with an automated 18-gauge core biopsy needle and gun, using either fluoroscopic or CT guidance. One hundred six lesions were biopsied in 103 patients between 1992 and 1998. Hard-copy images, imaging reports, pathology reports and clinical notes were reviewed. In 3 patients it was not possible to establish the lesion as either malignant or benign from the available follow-up, so these were removed from the analysis of diagnostic accuracy. Adequate samples for histological diagnosis were obtained in 104 of 106 (98 %) biopsies. There were 75 of 85 (88 %) true-positive core biopsies for malignant lesions and a specific cell type was identified in 70 of 85 (82 %) cases. A specific histological diagnosis was obtained in 12 of 18 (66 %) biopsies. There was a 19 % rate of pneumothorax with only 2.4 % requiring drainage. Minor haemoptysis occurred in 3.8 % of procedures. The TNB technique with an automated core biopsy needle provides a high level of diagnostic accuracy, effectively distinguishes cell type in malignancy and provides a definite diagnosis in benign disease more frequently than fine needle aspiration (FNA). There is no increased complication rate compared with FNA. Received: 26 January 1999; Revision received: 1 July 1999; Accepted: 2 July 1999     

Endoluminal grafting of abdominal aortic aneurysms: experience with the Talent endoluminal stent graft

The aim of this study was to evaluate the Talent endoluminal stent graft (TESG) in treating abdominal aortic aneurysms (AAA). The TESG is a polyester-covered nitinol endograft (proximal diameters 20–38 mm and iliac limb diameters 8–22 mm). Twenty-two men were treated with the TESG via bilateral femoral arteriotomies. Pre-implantation, coil embolization of various vessels arising from the aneurysm was performed in 6 patients. Plain radiographs and spiral CT angiograms (CTA) were carried out at 7 days, 3, 6, and 12 months following TESG implantation or re-intervention. Median aortic and iliac diameters were 27 mm (range 20–34 mm) and 14 mm (range 10–19 mm). The corresponding graft diameters were 30 mm (range 24–38 mm) and 14 mm (range 12–20 mm). No patient was rejected purely on the basis of too large aortic or iliac diameters. Eight patients required custom-made grafts. Graft implantation was successful in all patients. There were no blood transfusions, distal embolic episodes, or conversions to open surgery. Re-intervention was necessary in 1 patient. Complications included one fatal myocardial infarction, one inguinal hematoma, and two superficial wound infections. The aneurysm thrombosed completely following implantation in 14 patients and at 3 or 6 months in 4 other patients. One patient with endoleak is awaiting his 3-month control and 2 patients show tiny endoleaks but reduction of aneurysm size. The mean aneurysm size decreased significantly from 58 ± 10 to 53 ± 13 mm (p < 0.0005). Due to the large sizes available and the option of custom-made grafts, the TESG helps widen the spectrum of patients who can be treated with endoluminal grafting. The treatment is associated with a significant reduction in aneurysm size. Received: 30 March 1999; Revised: 6 July 1999; Accepted: 23 August 1999