CT demonstration of calcified liver metastases in medullary thyroid carcinoma

The presence of calcification can be found in greater than 50% of thyroid cancers. With medullary thyroid carcinoma, calcifications may be found in the primary lesion as well as in metastatic lymph nodes and in the liver. We report two cases of medullary thyroid carcinoma with associated calcified liver metastases.     

Hepatosplenic antracosilicosis: a rare cause of splenic calcifications

A case of a 62-year-old man with known longstanding pulmonary antracosilicosis, with associated hepatosplenic antracosilicosis, is presented. A CT scan of the upper abdomen revealed multiple calcifications within the spleen, and to a lesser degree within the subcapsular region of the liver, as well as "egg-shell" calcifications of abdominal lymph nodes, most noticeable at the splenic hilum. Although histopathologically not proven, the similar appearance of the calcified hepatosplenic nodules to the small round calcifications scattered throughout the lungs, as well as the typical "egg-shell" morphology of the calcified abdominal lymph nodes, should raise the suspicion of hepatosplenic antracosilicosis.     

甲状腺癌淋巴结转移的CT表现

目的：评价甲状腺癌淋巴结转移的CT特点。方法：回顾性分析经手术及病理诊断的108例甲状腺癌淋巴结转移的CT表现。结果：108例中，颈上中深组淋巴结转移76例，颈下深组及锁骨上窝86例，气管食管沟52例，纵隔17例。84例乳头状癌中，16例淋巴结密度与正常甲状腺相似，24例有囊性变，其中18例淋巴结囊内有明显强化的乳头状结节，11例有细颗粒状钙化，24例滤泡癌，髓样癌，透明细胞癌中，17例淋巴结明显强化，17例与甲状腺原发或复发肿瘤密度一致，密度均匀或不均匀。结论：甲状腺癌转移淋巴结好发部位为颈静脉链周围，气管食管沟及纵隔；淋巴结明显强化，与正常甲状腺密度一致，囊性变，囊壁内明显强化的乳头状结节及细颗粒状钙化为甲状腺乳头状癌的特征性改变，淋巴结明显强化，与甲状腺肿瘤密度一致为滤泡癌，髓样癌，透明细胞癌转移淋巴结的特点。     

儿童腹膜后成神经细胞瘤侵犯肾脏与肾母细胞瘤的鉴别诊断

目的评价儿童腹膜后成神经细胞瘤侵犯肾脏与肾母细胞瘤的CT表现鉴别要点。方法分析经手术证实的有明确肾脏侵犯13例腹膜后成神经细胞瘤的CT征象，并与同期经手术证实的15例肾母细胞瘤进行对照。结果13例成神经细胞瘤中12例表现为不规则肿块，11例边界不清，10例包含钙化，9例腹膜后血管受侵犯，12例有腹膜后和膈脚后淋巴结转移；15例肾母细胞瘤中，12例呈圆形肿块，2例边界不清，2例有钙化，2例腹膜后血管受侵犯，3例有腹膜后淋巴结转移；无膈脚后淋巴结转移表现。其中神经母细胞瘤的肿瘤分叶征、钙化、腹膜后和膈脚后淋巴结转移、腹主动脉和下腔静脉包埋均较肾母细胞瘤常见。其中膈脚后淋巴结转移和腹膜后血管包埋对于诊断神经母细胞瘤具有较高价值。结论膈脚后淋巴结转移和腹膜后血管包埋是成神经细胞瘤的特征性表现，对于鉴别腹膜后成神经细胞瘤与肾母细胞瘤具有重要的意义。     

小甲状腺癌的CT表现分析

目的 分析小甲状腺癌的CT表现,探讨其CT征象.方法 对40例CT平扫及增强扫描后经手术病理证实的直径在1.0～2.0 cm的小甲状腺癌的CT表现进行回顾性分析.结果 (1)38例为单发癌灶,2例为双侧双发癌灶;2例合并对侧结节性甲状腺肿,1例合并对侧甲状腺腺瘤;(2)边缘光整,包膜完整者8个病灶;边缘不光整,包膜不完整者34个病灶,但未见明显周围软组织及重要器官侵犯;(3)病灶平扫密度均匀或较均匀,未见明显出血或坏死囊变区;病灶内伴钙化者30个病灶,钙化形态各异,以砂粒状多见(20个病灶),也可见不规则结节状、蛋壳状或桑椹状钙化;(4)增强后41个病灶明显强化(强化幅度＞40 HU,CT值在90～140 HU之间),其中38个病灶均匀强化,3个病灶中央强化明显,边缘可见一环形低密度影,呈镶嵌征;(5)伴颈部淋巴结肿大者24例(60.0%),可呈实性、囊实性或囊性,增强后可呈均匀明显强化、不规则环形强化或壁结节样强化;8例淋巴结内可见砂粒状、结节状或蛋壳状钙化.结论 砂粒状钙化、甲状腺包膜不完整、强化明显的甲状腺实性结节及伴钙化、囊变、实性部分明显强化的颈部肿大淋巴结为小甲状腺癌较为特征性的CT表现.     

Magnetic resonance imaging of mediastinal and hilar masses: comparison with CT

Magnetic resonance imaging (MRI) was compared to computed tomography (CT) of the mediastinum and/or hila in 37 patients with bronchogenic carcinoma (35 unresectable for cure) and 11 patients with other masses. Spin-echo pulse sequences using a short pulse repetition rate (TR) and short echo delay (TE) were most helpful for detection of abnormal soft-tissue mediastinal and hilar masses. The accuracy of MRI and CT in staging bronchogenic carcinoma for curative resectability/nonresectability was comparable. CT staged 35 of 37 cases appropriately, while MRI correctly staged 36 of 37 cases. Several pitfalls in MRI evaluation of the mediastinum were identified. By MRI the esophagus may be misinterpreted as an enlarged retrotracheal lymph node unless serial scans are studied. Scattered calcifications in enlarged mediastinal and hilar lymph nodes due to old granulomatous disease are not detectable by MRI. Small adjacent lymph nodes shown individually by CT may appear as a single enlarged lymph node by MRI due to partial-volume averaging. Small lung nodules may be undetected by MRI due to respiratory motion and partial-volume averaging. Certain patients are unsuitable for MR scanning. Because of the requirement for patient selection and the identified pitfalls of MRI, CT remains the radiologic procedure of choice in the staging of patients with bronchogenic carcinoma and the evaluation of other mediastinal and hilar masses at present. However, because of the ability to show blood vessels without an intravascular contrast agent, MRI is useful in evaluating patients with potential contrast allergy and solving diagnostic problems not solved by CT.     

Calcified lymph node metastases in bronchioloalveolar carcinoma

A 45-year-old man was found by cytopathologic examination of bronchial washings to have bronchioloalveolar carcinoma. A computed tomography (CT) scan of the chest showed diffuse calcifications in the consolidated left upper lobe. Similar calcifications were seen in several mediastinal lymph nodes; these were shown by biopsy to be metastases with calcified psammoma bodies. When CT demonstrates diffuse calcifications in a bronchioloalveolar carcinoma, the finding of identical calcifications in the mediastinal lymph nodes should raise a strong suspicion of metastatic involvement.     

Imaging of anaplastic carcinoma of the thyroid gland]

Sixteen cases of anaplasic thyroid carcinoma have been reviewed. In 13 cases out of 16, a diffuse invasion of one or both thyroid lobes and of the isthm associated with calcifications (50%) and necrosis (62%) was present. In 6 cases out of 8, CT Scan with contrast media injection has detected an extension into surrounding tissues. Twelve of the 16 patients presented cervical lymph nodes on the ultrasound examination and 4 of 8 patients presented mediastinal lymph nodes on the CT Scan. In 3 cases out of 16, the anaplasic carcinoma of the thyroid presented as a localized, hypoechoic nodule associated with a cervical lymph node in 1 case.     

肺结核的CT诊断

目的探讨CT对肺结核的诊断价值。方法回顾性分析56例具有完整临床资料的肺结核病人的CT表现,所有病例均经病理证实或经临床随访证实。结果56例肺结核中,主要CT表现为结核灶钙化22例,支气管播散灶17例,卫星灶21例,纵隔淋巴结肿大9例,其中环状强化8例,纵隔淋巴结钙化14例,多呈点状、环状及簇状。结论CT对诊断肺结核具有较高的价值,全面分析其CT征象,有助于肺结核的诊断。     

Psoas lymph node metastasis in patients with carcinoma of the uterine cervix

Enlargement of lymph nodes between the psoas muscle and lumbar spine was demonstrated on CT in three of 14 cases having Stage IIb and III uterine cervical carcinoma with iliac or paraaortic lymphadenopathy. In two of these, the adjacent lumbar vertebral body was destroyed. We define psoas lymph nodes to include all lymph nodes located between the psoas muscle and the spine. Psoas lymph nodes may be divided into upper and lower groups: the upper group distributed along the lumbar arteries above in level of L4-L5 and the lower group distributed along the lumbar branches of the iliolumbar arteries below L5. There appears to be paravertebral communication between these two groups. The region of the psoas lymph nodes should be scrutinized in interpretating CT in patients with malignant pelvic tumors which have already spread to iliac or paraaortic lymph nodes. Obliteration of fat plane between psoas muscle and lumbar vertebra is a clue to the presence of enlargement of the psoas lymph nodes on CT. Massive enlargement of psoas lymph nodes may be difficult to distinguish from metastasis to psoas muscle. In such cases, MR imaging would be of help to differentiate these two conditions.     

Upper abdominal lymph nodes: criteria for normal size determined with CT

Reports of the upper limits of normal for lymph node size at abdominal computed tomography have varied from 6 to 20 mm. Establishment of an upper limit for node size by specific location, analogous to that which has been reported for mediastinal lymph nodes, was sought. Short-axis diameters of the lymph nodes were measured in 130 patients who were not likely to have enlarged abdominal lymph nodes. Seven locations were defined, and the largest nodal measurement for each was recorded. Histographic analysis and nonparametric statistical methods were used to determine threshold values for the maximum node size in each region. The upper limits of normal by location were as follows: retrocrural space, 6 mm; paracardiac, 8 mm; gastrohepatic ligament, 8 mm; upper paraaortic region, 9 mm; portacaval space, 10 mm; porta hepatis, 7 mm; and lower paraaortic region, 11 mm. Lower paraaortic lymph nodes larger than 11 mm by short-axis measurement are abnormal. In other locations, nodes smaller than 1 cm may be abnormal if the determined thresholds are exceeded.     

Punctate intranodal gold deposits simulating microcalcifications on mammograms

Some axillary lymph nodes are frequently seen on mammograms. Rarely, such nodes will demonstrate opacities that appear to be multiple punctate calcific deposits. The literature is of little guidance as to the meaning of this appearance. One report indicates that breast cancers that are manifested as extensive punctate calcifications very rarely occur in this pattern in metastatically involved axillary lymph nodes. The authors suggest that such punctate densities are much more often indicative of intranodal gold deposits and that they occur almost invariably in patients with rheumatoid arthritis who have undergone prolonged chrysotherapy. This observation was confirmed in one patient and suspected in three others with similar clinical histories.     

Ultrasonic diagnosis of the central hyperechogenic area in lymph nodes. A sign of benign lymphadenopathy

When identifying superficial lymphadenopathies by means of echotomography, the only accepted criterium of evaluation is still dimension. Only lymph nodes with a diameter longer than 0.5 cm are considered as potentially pathological, irrespective of their morphological characteristics. In the past two years an echotomographic study of the surface regions was carried out on 300 patients. Some suffered from unspecific solitary lymphadenopathies; most of the others were affected by stationary neoplasias, mainly situated in the cervical region. In many cases it has been possible to correlate the echotomographic and the histological results. Sixty-nine out of the 300 examined patients had lymph nodes with a central hyperechogenic area. Histology showed these lymph nodes to be the site of reactive hyperplasia. This characteristic has never been found in neoplastic lymph nodes. It has been hypothesized that this spot corresponds to the hilus of the lymph node and that, through its identification, it may be possible to distinguish benign from neoplastic lymph nodes.     

Calcification of axillary lymph nodes following BCG vaccination

Axillary lymph node calcification was found in 18 children following BCG vaccination. Five of these also had symptomatic adenitis. The calcifications involved one to four nodes and appeared as discrete, oval densities. They disappeared over the course of several months in three patients. No axillary lymph node calcification was seen on chest radiographs of 60 other children who had had BCG vaccination in the neonatal period.     

Intrapulmonary lymph nodes: CT and pathological features.

Intrapulmonary lymph nodes are not uncommon and may be seen frequently in high quality computed tomography (CT) images and chest radiographs. We report four patients, older than 55 years, who had a long history of heavy smoking. Four intrapulmonary lymph nodes were located in the subpleural region (within 3 mm of the visceral pleural surface) of the right or left lower lobes. The lymph nodes were ovoid or round, homogeneous, well-defined and ranged from 9 to 10 mm in diameter. In one case, coexistent small nodules in the same or in other lobes on initial CT studies increased slightly in size over the following 3 years. All nodules contained lymphoid follicles and anthrocotic pigment, and in one case adjacent small aggregates of lymphocytes along interlobular septa were seen. Intrapulmonary lymph nodes have non-specific CT and clinical features. Follow-up CT may be useful in patients with suspected intrapulmonary lymph nodes.     

A case of metastatic breast cancer showing extraosseous accumulation of 99mTc-HMDP in axillary lymph nodes on bone scintigraphy]

We report a case of metastatic breast cancer that showed extraosseous accumulation of 99mTc-HMDP in left axillary lymph nodes on bone scintigraphy. Our patient had a giant left breast mass and multiple lymph node metastases with atypical calcifications. It is known that breast cancer sometimes is positively visualized as extraosseous accumulation on bone scintigraphy. Accumulation to metastatic lymph nodes of breast cancer has rarely been reported. It is suggested that bone scintigraphy is of benefit in detecting the metastatic lymph nodes of breast cancer as a screening or follow-up method.     

Syndesmo-odontoid joint and calcium pyrophosphate dihydrate deposition disease (CPPD)

Twenty-seven patients with definite or probable CPPS have been investigated with systematic frontal and lateral tomograms of the cervicooccipital region. In 12 cases there were calcifications of the syndesmo-odontoid region. These calcifications are of two different types: linear calcifications (5 cases) and mottled calcifications (7 cases). The anatomic location of these calcifications is the transverse ligament or other structures of the syndesmo-odontoid joint. Although this type of calcification has already been described in other rheumatic diseases, it must lead to search for CPPD in the usual locations.     

腋窝内脂肪浸润淋巴结的X线表现

目的认识日常工作中乳腺X线检查中腋窝内脂肪浸润淋巴结的发生情况及其X线表现.资料与方法回顾性分析436例乳腺X线检查中MLO位片上两侧腋窝内脂肪浸润淋巴结的检出率及其X线表现,并与同时见到的无脂肪浸润淋巴结作了比较.结果 178例(40.83%)见有腋窝淋巴结,其中104例(58.4%)有脂肪浸润,35例(19.7%)无脂肪浸润,两者共存者40例(22.5%),有脂肪浸润者显著多于无脂肪浸润者(P＜0.01).在形态上,有脂肪浸润者中多呈有特征性的中央或一侧较低密度的卵圆形或新月形,其边缘多部分或全部边缘不清(86.1%).有脂肪浸润者最大可达35 mm,其长径和短径分别平均为13.8 mm和7.2 mm,都要大于无脂肪浸润者,后者分别为7 mm和5 mm(P＜0.01).结论腋窝内含脂肪淋巴结很常见,有一定特征性X线表现,认识它们有利于鉴别诊断,以免误诊.     

Breast cancer metastasis to intramammary lymph nodes

Metastatic disease to the intramammary lymph nodes from breast cancer may be seen mammographically. In the four cases reviewed, the affected intramammary lymph nodes were enlarged (1 cm or greater in diameter), homogeneous, and well circumscribed. All lacked the lucent center or hilar notch characteristic of benign intramammary nodes. Differentiation of malignant from benign causes of intramammary lymph node enlargement, such as inflammation or hyperplasia, is impossible by mammography. Biopsy is recommended for all intramammary lymph nodes of 1 cm or greater that are not fat infiltrated unless the patient clearly has an associated dermatitis or mastitis. Metastatic disease to the intramammary lymph nodes may be the first clinical and/or mammographic sign of breast cancer and may significantly affect prognosis.     

Physiologic and pathologic calcifications and ossifications in the face and neck

The aim was to give a systematic presentation of physiologic and pathologic calcifications and ossifications in the face and neck with a special emphasis on clinical relevance. In a sometimes subacute setting one should recognize specific calcifications which often lead to important diagnoses such as fungal sinusitis or sclerosing labyrinthitis. In a more chronic situation intraocular calcifications in small children are pathognomonic for retinoblastoma. Juxtatumoral sclerosis of the laryngeal cartilage in laryngopharyngeal carcinoma is usually caused by tumor infiltration of the cartilage resulting in a higher tumor stage and, this way, has a major impact on the therapeutical strategy. Calcified lymph nodes are mainly unspecific but can be the result of tuberculosis or metastases of thyroid cancer. Cross-sectional imaging methods, most of all computed tomography, are ideally suited to reveal head and neck calcifications and ossifications, especially those which are clinically relevant.