Computed tomography of Tietze syndrome

Six patients with clinical features suggestive of Tietze syndrome had a thoracic computed tomographic (CT) examination following a normal plain film or tomographic examination (or both) of the affected costochondral junction. A chest wall mass was excluded in all six patients. The CT findings included enlargement of the costal cartilage at the site of complaint (two patients), ventral angulation of the involved costal cartilage (two patients), and normal anatomy of the costochondral junction (two patients). Exclusion of a chest wall mass by CT may obviate the need for operative intervention.     

胸部腹外型侵袭性纤维瘤病的CT表现

目的：分析发生于胸部的腹外型侵袭性纤维瘤病的CT表现,提高对本病的诊断水平。方法：回顾性分析19例经手术病理证实的胸部侵袭性纤维瘤病患者的CT 表现。19例均行 CT 平扫,9例行增强扫描,1例行 CTA 检查。结果：19例共检出23个病灶,其中3例为多发病灶（发生于软组织1例、骨骼2例）。病变位于软组织15例共16个病灶（两侧和前胸壁8个、背部5个、肩部1个、腋窝1个）,位于骨骼4例共7个病灶（肋骨5个、胸肋关节1个、胸骨上段1个）。16个软组织肿块中呈类圆形或梭形13个,分叶形或不规则形3个;边界不清13个,边界清晰3个（其中2个有假包膜）;CT平扫表现为等或低密度肿块14个,囊实性肿块2个,3个病灶内可见钙化（分别呈点状、弧形和爆米花样）;增强扫描9例共10个病灶中,表现为轻度均匀强化2个,明显不均匀强化2个,边缘轻度强化1个,边缘明显强化2个,轻中度不均匀强化2个,多发小圆形轻中度环形强化1个;5个病灶可见肿瘤与骨质粘连伴骨质破坏。4例共7个骨骼病灶,CT 平扫6个表现为骨内软组织肿块、膨胀性骨质破坏（1个出现周缘硬化边）,1个表现为软组织肿块伴有局限性骨皮质压迫吸收;肿块呈较低密度3个,等或稍低密度3个,稍高密度1个;1例行增强扫描,肿瘤呈轻度～中度不均匀强化。结论：胸部侵袭性纤维瘤病的CT表现有一定特征性,CT对本病具有较高的诊断价值。     

多层螺旋CT及重建技术在胸部创伤中的临床应用

目的:讨论多层螺旋CT(MSCT)扫描及重建技术在胸部创伤中的临床应用价值。方法:57例胸部创伤病人行MSCT扫描,重建层厚2.5 mm,间隔1.25 mm,将数据传至专门工作站,对骨性胸廓进行多平面重建(MPR)、薄层最大密度投影(STS-MIP)及容积再现(VR)重建,对横断面图像及重建图像进行回顾性分析。结果:57例胸部创伤患者中,发现肺挫伤44例,肺撕裂伤4例,肺不张及肺萎缩11例,气胸27例,胸腔积液42例,肋骨骨折36例,肋软骨骨折2例,肩胛骨骨折6例,锁骨骨折3例,胸椎骨折1例。MPR图像可清楚显示骨折线的走行及移位,3D重建图像从各个方位显示了骨折的空间改变。结论:多层螺旋CT扫描能够清晰显示肺部损伤情况,胸廓重建图像可以显示骨折的立体空间改变,两者相结合,对临床制定治疗方案具有重要的参考价值。     

The role of CT analyses of the sternal end of the clavicle and the first costal cartilage in age estimation

The ossification patterns of medial clavicle and the first costal cartilage represent interesting features of the same anatomical region which are accessible for conventional radiographic and computed tomography (CT) examinations in the same field of view. This study encompassed Serbian population and was carried out to examine whether CT analyses of medial clavicle and the first costal cartilage could be successfully applied, either individually or conjointly, in the age assessment. The study was based on CT examinations of thoracic region of 154 patients, aged between 15 and 35 years. Besides radiodensity and stages of epiphyseal cartilage ossification of medial clavicle, the study detected other features that expressed significant correlation with age, such as calculated anterior to posterior cortical thickness ratio, medullar canal diameter, and clavicular shaft diameter. However, although calculated ossified and calcified linear projections’ (OCP) stages correlated to age, the distinction between stages was not satisfying. The interaction between the ossification status of medial clavicle and OCP was not significantly influenced by age. The results of our study outlined interesting new age predictors with mutual relationship: acquired radio density of the sternal epiphyseal-metaphyseal region and radio density of the first costal cartilage. Intersex variability was observed in several age-related features: calculated anterior to posterior cortical thickness ratio, diameter of medullar canal, and diameter of the clavicular shaft. Altogether, our study identified several radiological features of the first costal cartilage and medial clavicle that correlated with age and which could be applied as additional guidance for age estimation in each specific case.     

木村病的影像表现及文献复习

目的 探讨不同部位木村病的CT及MRI表现.方法 收集本院经病理证实19例木村病患者的CT和MRI行回顾性分析,并结合文献讨论.结果 19例木村病中累及头颈部16例、肺内1例、胸壁1例、肝脾受累1例.头颈部木村病CT表现为结节、团块及弥漫性密度异常,平扫与肌肉密度相似,T1WI呈等或稍低信号,T2WI呈高信号,CT和MRI增强扫描多为中度或明显强化.肺内及胸壁木村病表现为软组织肿块,增强扫描肺内病灶呈中度强化,胸壁病灶呈环形强化.肝脾同时受累木村病病灶呈散在结节状轻度强化灶.结论 木村病影像学表现缺乏特征性,需结合实验室检查及病理综合判断.     

Novel Influenza A (H1N1) Virus Infection in Children: Chest Radiographic and CT Evaluation

Objective

The purpose of this study was to evaluate the chest radiographic and CT findings of novel influenza A (H1N1) virus infection in children, the population that is more vulnerable to respiratory infection than adults.

Materials and Methods

The study population comprised 410 children who were diagnosed with an H1N1 infection from August 24, 2009 to November 11, 2009 and underwent chest radiography at Dankook University Hospital in Korea. Six of these patients also underwent chest CT. The initial chest radiographs were classified as normal or abnormal. The abnormal chest radiographs and high resolution CT scans were assessed for the pattern and distribution of parenchymal lesions, and the presence of complications such as atelectasis, pleural effusion, and pneumomediastinum.

Results

The initial chest radiograph was normal in 384 of 410 (94%) patients and abnormal in 26 of 410 (6%) patients. Parenchymal abnormalities seen on the initial chest radiographs included prominent peribronchial marking (25 of 26, 96%), consolidation (22 of 26, 85%), and ground-glass opacities without consolidation (2 of 26, 8%). The involvement was usually bilateral (19 of 26, 73%) with the lower lung zone predominance (22 of 26, 85%). Atelectasis was observed in 12 (46%) and pleural effusion in 11 (42%) patients. CT (n = 6) scans showed peribronchovascular interstitial thickening (n = 6), ground-glass opacities (n = 5), centrilobular nodules (n = 4), consolidation (n = 3), mediastinal lymph node enlargement (n = 5), pleural effusion (n = 3), and pneumomediastinum (n = 3).

Conclusion

Abnormal chest radiographs were uncommon in children with a swine-origin influenza A (H1N1) virus (S-OIV) infection. In children, H1N1 virus infection can be included in the differential diagnosis, when chest radiographs and CT scans show prominent peribronchial markings and ill-defined patchy consolidation with mediastinal lymph node enlargement, pleural effusion and pneumomediastinum.     

MR evaluation of chest wall involvement in malignant lymphoma

Chest CT and magnetic resonance (MR) examinations of 28 patients with newly diagnosed or recurrent lymphoma involving the mediastinum were retrospectively evaluated for evidence of chest wall involvement. Computed tomography demonstrated seven sites of chest wall involvement in four patients; whereas MR demonstrated 14 sites in seven patients, including all sites shown by CT. Eight chest wall lesions were located in the extranodal soft tissues (three sites were contiguous with anterior mediastinal lymphadenopathy; three sites were contiguous with pleural/parenchymal disease; and one each involved the breast and multiple vertebral bodies). Six sites involved lymph nodes in the interpectoral (n = 4), submammary (n = 1), and infraspinatus (n = 1) areas. Lesion conspicuity in the chest wall was better on T2- than T1-weighted sequences and was best on short inversion time inversion recovery. Detection of chest wall lymphoma may alter staging; when present in this group of patients, it influenced management in two of the seven patients.     

Demonstration of excessive metabolic activity of thoracic and abdominal muscles on FDG-PET in patients with chronic obstructive pulmonary disease

PURPOSE: The purpose of this study was to determine if an FDG-PET study was able to visualize muscle uptake of the chest and abdomen in patients with chronic obstructive pulmonary disease (COPD). METHODS: This study included 25 patients with COPD and 25 patients without COPD who had undergone a FDG-PET study. The nonattenuation-corrected images were used to determine the degree of FDG uptake in the intercostals, subscapular, abdominal rectus, and abdominal oblique muscles. The intensity of uptake in the muscles was rated on a 4-point grading scale with 1 being less, 2 the same, 3 slightly more, and 4 markedly more intense than the sternum. RESULTS: Thirteen patients with COPD demonstrated FDG activity in the intercostal muscles that was equal to or greater than the sternum and the tracer was demonstrated predominantly in the inferolateral chest wall (n = 8), the entire lateral chest wall (n = 2), the posteroinferior chest wall (n = 2), and the entire chest wall (n = 1). In all 13 patients with COPD who demonstrated FDG activity in the abdominal oblique muscles, the site of muscle activity was predominantly in the anteroinferior abdominal wall (n = 8), the lateral wall (n = 4), and the anterior wall (n = 1). In patients without known COPD, the frequency and intensity of uptake in the muscles were less than those with the disease. CONCLUSION: This study demonstrates the ability of FDG-PET imaging to assess muscle function in respiratory disorders and may prove to be of some value in further characterizing this disorder.     

Cine MRI of the thorax in patients with pectus excavatum

BACKGROUND: Morphologic and dynamic assessment of respiratory chest kinetics was performed in patients with pectus excavatum deformity (PE) using dynamic MRI: cine MRI. MATERIAL AND METHODS: Seven consecutive patients with PE (aged 20.3 years+/-4.0) and ten healthy volunteers of comparable age underwent real-time cine MRI of the chest during breathing on a 1.5 T MR scanner (Magnetom Sonata, Siemens Medical Systems, Erlangen, Germany) using a standard phased array body coil and a half-Fourier single-shot turbo spin echo sequence (HASTE) for dynamic imaging. During deep inspiration and expiration, single-shot sequences were performed in one slice level over 20 s at a frequency of 1 image/s covering the entire thoracic cage in three orientations. Morphology and chest kinetics in patients with PE were analyzed and compared with normal values, and typical patterns of chest kinetics were noted. RESULTS: Three different types of chest morphology in PE were identified: (1) the generally flattened thoracic cage, (2) the "tilted" sternum, and (3) the focally deepened sternum. Three patterns of motion correspond to these morphological types: (1) elevation of the sternum and the anterior thoracic wall, (2) angulated elevation of the parasternal rib cage with persistent deepening of the sternum resembling a "wing beat" movement, and (3) increased diaphragmatic movements with limited chest wall dynamics. CONCLUSIONS: Cine MRI is an adequate radiation-free diagnostic modality for the dynamic imaging of both chest morphology and chest wall kinetics in patients with PE. The pectus severity index can easily be determined and three typical movement patterns of chest wall kinetics identified.     

急性胃肠道穿孔的CT诊断

目的分析急性胃肠道穿孔的CT表现及其诊断价值。方法收集17例急性胃肠道穿孔患者术前腹部CT检查资料,与手术结果对照。结果胃窦前壁穿孔4例,幽门前壁穿孔1例,胃小弯前壁穿孔5例,十二指肠球部穿孔4例,肠穿孔3例。胃肠道穿孔的CT表现:直接征象有管壁不规则,周围脂肪层模糊;间接征象为腹腔内散在游离气体,以及穿孔引起的一系列并发症。结论CT对临床症状较轻,X线透视膈下无游离气体的胃肠道穿孔患者有较高的诊断价值。     

Pectus deformities: tomographic analysis and clinical correlation

Objective  

To assess, with computed tomography (CT) studies, features of anterior chest wall development that can be related to different types of pectus deformities.     

Costal cartilage fractures as revealed on CT and sonography

OBJECTIVE: We describe the CT and sonographic appearance of 15 costal cartilage fractures observed in eight patients. CONCLUSION: On CT, fracture was seen as a low-density area through the costal cartilage, with surrounding calcifications present near old fractures, and gas density within the cleft in some cases. On sonography, cartilage fracture appeared as an interruption of the smooth anterior aspect of the cartilage.     

胸腹部未成熟畸胎瘤的CT表现

目的：探讨胸腹部未成熟畸胎瘤的CT诊断价值。方法：回顾性分析31例胸腹部未成熟畸胎瘤的CT资料。结果：31例未成熟畸胎瘤中有不均质实性肿块27个和厚壁囊性肿块4个,平均最大径14．3cm。26例可见散在钙化,大多有散在脂质和盘曲的带状略低密度影。8例肿瘤向外突破包膜侵犯邻近脏器。16例伴有胸腹腔或者心包积液。结论：胸腹部未成熟畸胎瘤的CT表现具有一定特征,了解这些特征有助于胸腹部未成熟畸胎瘤的诊断和鉴别诊断。     

胸部脂肪瘤的影像学诊断(附14例报告)

目的探讨胸部脂肪瘤的影像学表现及检查方法优选. 资料与方法搜集胸部脂肪瘤14例资料,包括肺脂肪瘤2例,胸壁脂肪瘤4例,纵隔脂肪瘤3例,胸腺脂肪瘤3例,横膈脂肪瘤1例,右心房脂肪瘤1例,全部病例均有胸部正侧位片,12例进行了CT检查,1例进行了MRI检查,对全部患者的影像学表现进行分析. 结果胸部正侧位片病灶发现率78.6%,漏诊原因与肿瘤密度过低,肿瘤沿胸壁深部肌间隙浸润生长或肿瘤位于平片上较隐蔽的部位有关.CT检查不仅可进行精确的定位诊断和分类诊断,而且能作出定性诊断,但应常规摄脂肪窗片.MRI对这类肿瘤最敏感,它对病变的发现、定位、分类诊断及定性诊断有决定性意义. 结论胸部正侧位片是胸部脂肪瘤的首选检查方法,但病变的分类诊断与定性诊断需依赖胸部CT与MRI,其中MRI是该类疾病的最佳检查方法.     

Unexpected subdiaphragmatic findings on CT of the chest in septic patients after cardiac surgery

AIM: to draw the attention to upper abdominal abnormalities, which may be revealed incidentally in patients referred for a chest computed tomography (CT) after cardiac surgery. MATERIALS AND METHODS: We reviewed prospectively and retrospectively the CT results of all patients referred for a chest CT, with suspected sternal infection or for other reasons, after cardiac surgery, to assess possible upper abdominal disease as visualized on lower cuts of the chest CT with abdominal windows. RESULTS: Out of a total of 205 patients in the study 39 (19%) had unexpected abdominal abnormalities. The organs involved in decreasing order of frequency were the spleen (n = 18), gallbladder (n = 15), pancreas (n = 9), kidneys (n = 6) and bowel (n = 3). Many patients had involvement of more than one organ. The lesions were mainly ischaemic and/or infectious in origin. These findings led to interventional procedures in 13 (33%) of the patients with a good outcome. CONCLUSIONS: We found a relatively high prevalence of abdominal abnormalities on CT of the chest in patients referred with suspected thoracic problems after cardiac surgery. Major findings on CT led to changes in the management of these patients. We recommend therefore viewing lung bases with abdominal windows as well as adding sections through the upper abdomen in patients who are referred for a chest CT after cardiac surgery with suspected thoracic problems.     

多层螺旋CT在儿童颈部囊状淋巴管瘤的应用

目的:探讨MSCT对儿童颈部囊状淋巴管瘤的诊断价值.方法:回顾性分析15例经病理证实的儿童颈部囊状淋巴管瘤MSCT表现并与手术病理所见对照.结果:儿童颈部囊状淋巴管瘤MSCT的特点:①多囊性;②可出现"液-液平面"征象;③沿疏松结缔组织生长;④增强扫描囊壁不强化或轻度强化,囊内容物不强化;⑤肿瘤包绕血管、神经及脂肪;⑥MSCT可以水平横断面、冠状面、矢状面结合显示病灶.结论:MSCT检查对儿童颈部囊状淋巴管瘤的诊断具有重要价值,有利于手术方案的制订,在评价肿瘤侵犯方面优于超声和普通CT.     

MSCT在肋软骨骨折诊断中的临床应用

目的探讨螺旋CT重建在肋软骨损伤中的临床应用价值。方法对65例有明确外伤史患者,进行胸部常规螺旋CT扫描,全部原始图像传送至AW4.1工作站进行多平面重建(MPR)、容积重建(VR)处理以显示肋软骨骨折。结果65例受检者的CT图像经过后处理显示29例有肋软骨骨折,CT表现为肋软骨条状影或钙化影中断或不连续,断端错位伴有局部软组织肿胀。结论MSCT能够显示完整的胸廓组成,尤其对外伤引起的软骨骨折的显示,是一种良好的肋软骨影像学检查方法。     

胸壁肿块的CT诊断

目的分析胸壁肿块的CT表现,提高其诊断水平。方法 30例临床证实的胸壁肿块患者均经CT平扫,10例又经增强扫描。对所有患者的CT表现进行了回顾性分析。结果在CT像上,胸壁结核(5例)表现为胸壁内软组织密度肿块影;细菌性脓肿(4例),表现为局限性软组织肿块影,密度不均匀;脂肪瘤(4例)表现为胸壁内局限性脂肪密度肿块影;神经源性肿瘤(5例)表现为胸壁内密度均匀、边界清楚的软组织肿块影;血管瘤(1例)表现为左侧胸壁散在条状迂曲的软组织密度肿块影,增强后明显强化;胸膜间皮瘤(3例),其中良性者(2例)表现为局限性胸膜增厚,恶性者(1例)表现为弥漫性胸膜增厚伴胸腔积液;胸膜转移瘤(3例)表现为胸膜结节状增厚;肋骨转移瘤(4例)表现为胸膜结节状增厚;Askin瘤(1例)表现为右侧胸壁内及胸膜处软组织肿块影伴邻近肋骨骨质破坏。结论 CT对胸壁肿块的定位及良、恶性鉴别具有重要价值,尤其64排螺旋CT及其后处理技术更有利于其诊断与鉴别诊断。     

成人环状软骨水平的下咽部正常CT表现及临床意义

目的 探讨CT图像上环状软骨水平的下咽部的正常表现及其临床意义.方法 回顾性分析84名正常成人下咽部的CT图像,将下咽部分成梨状窝区、咽后壁区和环后区,把下咽部的环后区划分为如下3个层面,即环状软骨上缘层面(经环杓关节水平);环状软骨中部层面;环状软骨下缘层面.分别测量环后区的前后径、横径及其前、后壁的厚度;观察黏膜下脂肪层的变化,并对周围相毗邻的其他结构和脂肪组织进行观察、分析.测量数据采用t检验和x2检验进行统计学分析.结果 环后区的后壁较同层面的前壁厚(0.9±0.4)mm.男性环后区的横径较女性宽(4.5±0.3)mm;横径在性别上差异有统计学意义[在环状软骨上缘层面,男性的横径为(38.6±3.3)mm,女性的为(34.4 4-2.5)nun,t=6.26,P<0.05;在环状软骨中部层面,男性的横径为(33.6±3.6)mm,女性的为(28.9±2.8)mm,t=6.36,P<0.01;在环状软骨下缘层面,男性的横径为(28.6 4-3.1)111111,女性的为(24.0±2.1)mm,t=7.52,P<0.01].环状软骨上缘水平的环后区的横径较环状软骨下缘水平的横径宽(10.1±2.4)mm.黏膜下的脂肪层从环状软骨上缘[显示率为81.0%(68/84)]至环状软骨下缘[显示率为23.8%(20/84)]逐渐减少.在环后区周围毗邻的脂肪组织中,每一层面环后区后侧的脂肪组织显示的概率最小,而其左侧的脂肪组织最易显示,这种差异具有统计学意义[在环状软骨上缘层面,环后区左、右、后方毗邻脂肪组织的显示率分别为77.4%(65/84)、72.6%(61/84)、28.6%(24/84),x2=24.64,中部层面,各显示率分别为89.3%(75/84)、75.0%(63/84)、34.5%(29/84),x2=24.76,在环状软骨下缘层面,各显示率分别为95.2%(80/84)、88.1%(74/84)、52.4%(44/84),x2=13.59,P值均<0.01].结论 环状软骨水平的下咽部的正常CT表现及变化在对下咽部疾病的诊查中起着重要作用.     

MSCT在肋软骨骨折诊断中的临床应用价值

目的：探讨多层螺旋CT（MSCT）在肋软骨骨折诊断中的应用价值,提高诊断水平。方法：回顾性分析21例共35处肋软骨骨折的多层螺旋CT表现和临床资料。结果：本组21例共35处肋软骨骨折,CT表现特征为肋软骨钙化中断伴明显错位、肋软骨条状高密度影不连续伴明显错位或错位不明显。结论：多层螺旋CT能清晰显示肋软骨骨折的部位、数目、形态及移位情况,对肋软骨骨折的诊断具有重要价值。