Acute liver failure due to trovafloxacin: CT findings

Symptomatic drug-induced hepatic adverse events due to trovafloxacin, a new fluoroquinolone antibiotic, are uncommon, but recent severe reactions have led to restriction on its use. We report the clinical course and computed tomography findings in a patient who developed acute liver failure shortly after commencing treatment with trovafloxacin. Extensive hepatic necrosis occurred and the patient ultimately died of her liver disease.     

Radiographic and computed tomographic findings in hydatid disease of bone

Twenty-six patients with hydatid disease of bone were evaluated by means of radiography and conventional tomography. Fourteen patients underwent high resolution computed tomography (CT). In two patients with vertebral disease, magnetic resonance imaging (MRI) examination was also performed. Seventeen patients underwent surgery with histological examination in all. Based on the surgical data and gross examination of the specimen, the radiographic and CT findings have been reviewed to identify the most characteristic radiographic features and to assess the role of CT. Radiographic findings of hydatidosis are rarely typical in bone, and only in a few patients can CT contribute to the diagnosis. On the other hand, the local extension of the lesion both in bone and in soft tissues, which is essential in planning surgery, is always demonstrated well by CT.     

Hemorrhagic necrosis due to peliosis hepatis: imaging findings and pathological correlation

Peliosis hepatis is an uncommon liver condition characterized by blood-filled cavities. We report the CT, angiographic and MR features of a case of peliosis hepatis with no obvious etiology and spontaneously regressing hemorrhagic necrosis. Helical CT showed multiple peripheral low-density regions with foci of spontaneous high density suggesting the presence of blood component. On MR imaging, the multiple peripheral lesions were hypointense on T1-weighted and hyperdense on T2-weighted images, with bright foci on all sequences suggesting subacute blood. Angiography showed no evidence of tumor or vascular malformation; multiple nodular vascular lesions filling in the parenchymal phase and persisting in the venous phase suggested blood-filled cavities. Pathological examination showed blood-filled spaces with no endothelial lining, characteristic of the parenchymal type of peliosis. Knowledge of the imaging features of hemorrhagic necrosis due to peliosis hepatis is important since it can be responsive to antibiotic therapy. Furthermore, differentiating hemorrhagic necrosis from hepatic abscess avoids dangerous and sometimes fatal percutaneous drainage. Received: 24 September 1997; Revision received: 20 February 1998; Accepted: 27 May 1998     

Femoral stress fractures in children

Stress fractures reported in the medical literature almost exclusively affect young athletes, military recruits and patients with metabolic bone disease. The classification of stress-induced bone injury is somewhat confused and includes fatigue stress freactures which occur in previously normal bones and insufficiency stress fractures which occur in bones weakened by various causes. Femoral stress fractures in children are extremely rare, and we report 5 cases in young patients who sustained their injuries during the course of normal play activities. It is well-known that these lesions can simulate malignant lesions; however, we believe that careful review of the radiographs in the context of the clinical history can in many cases lead to the correct diagnosis being made and obviate the need for further intervention.     

Asymptomatic sacroiliitis in inflammatory bowel disease assessment by computed tomography

Plain film radiographs and computed tomography scans of sacroiliac joints in 65 asymptomatic patients with known inflammatory bowel disease were performed and evaluated by two radiologists. Computed tomography revealed the presence of asymptomatic sacroiliitis in 21 (32%) of the 65 patients (New York grades 2 to 4); asymptomatic sacroiliitis was identified by plain film radiography in only 10 (18%) of 57 patients (p < 0.001). No correlation was observed between the presence or absence of sacroiliitis, and the age and sex of patients, disease type, or duration of disease. The prevalence and diagnostic value of computed tomography in the detection of asymptomatic sacroiliitis in patients with inflammatory bowel disease are discussed.     

Massive ischemic cerebellar infarction due to cocaine use

Summary This young female suffered massive unilateral infarction of the cerebellum due to cocaine use. While cocaine-associated small, asymptomatic cerebellar infarcts have been reported in the literature, massive, symptomatic cerebellar infarction attending the use of cocaine has not been previously reported.     

Caseous mitral annular calcifications: Multimodality imaging characteristics

The authors report herein a series of 3 patients with caseous mitral annular calcifications (MAC). One of the patients presented with mass-like, caseous MAC as an incidental finding on a staging computed tomography (CT) for metastatic colorectal carcinoma. Another patient presented with a nodule on a chest radiograph, which was later found on CT to be due to caseous MAC. In the third patient, caseous MAC was initially detected on echocardiography, and was further evaluated with CT and cardiac magnetic resonance imaging. In all three patients, the appearances posed a diagnostic dilemma. The appearance of caseous MAC is dissimilar to non-caseous MAC and is usually seen as an ovoid, mass-like structure, with homogeneous hyperattenuation, representing a liquefied form of calcium and proteinaceous fluid. This homogeneous center is surrounded by peripheral, shell-like calcifications. Caseous MAC is likely an under-recognized entity and may present a diagnostic dilemma at CT, magnetic resonance imaging, or echocardiography.     

Coronal thick CT reconstruction: an alternative for initial chest radiography in trauma patients

It has been proposed that the imaging workup of trauma patients be accelerated by omitting the initial chest radiography (CR) and directly performing a computed tomography (CT); however, the baseline CR is then lacking. The purpose of this study was to assess if coronal thick reconstructions generated from chest CT could present an adequate alternative for CR. Sixty trauma patients underwent bedside CR and multidetector row chest CT in the emergency room. The image quality of thoracic anatomical structures, the diagnostic accuracy for chest pathology, and the depiction of indwelling devices were assessed on both modalities. Main pulmonary arteries and perihilar bronchi were equally visualized with both modalities. Central bronchi, retrocardial lung parenchyma, diaphragm, descending aorta, and vertebral pedicles were better visualized on thick CT reconstructions, whereas peripheral lung vessels were better depicted on CR (p<0.05). The accuracy to delineate various pathological findings did not differ between both modalities, except for a higher sensitivity to diagnose bronchial cuffing on CR (p<0.05). The location of indwelling devices was similarly and correctly depicted with both modalities. Coronal thick CT reconstructions provide a similar image quality and diagnostic accuracy compared with CR. These reconstructions may serve as an equivalent baseline image in trauma patients in whom emergency radiological evaluation has to be accelerated.     

CT findings in a case of deficiency of 3-hydroxy-3-methylglutaryl-CoA-lyase

Summary Two CT scans have been performed on a child with a biochemically confirmed 3-HMG-CoA-lyase deficiency. Macrocephalus, widespread hypodensity of the white matter with cystic alterations and progressive dilatation of the ventricles were found. The clinical features and CT findings are surprisingly similar to findings in patients with spongy degeneration (Canavan).     

Suspected ureteral colic: plain film and sonography vs unenhanced helical CT. A prospective study in 66 patients

The aim of this study was to compare the sensitivity and specificity of plain abdominal films plus ultrasound, vs nonenhanced CT for the diagnosis of ureteral colic in patients with acute flank pain. During a 4-month period, 66 patients (mean age 48 years) with acute flank pain were prospectively studied by means of plain abdominal film, US, and unenhanced CT. The presence of lithiasis and of obstructive uropathy signs were determined. The plain film was only used as a guide for the US exam. Clinical follow-up of all patients was obtained. Ureteral lithiasis was confirmed in 56 patients. The CT had a greater sensitivity (93 vs 79%) and negative predictive value (71 vs 46%) for the detection of lithiasis. The combination of lithiasis plus obstructive signs showed a sensitivity and a specificity of 100% for CT and of 100 and 90%, respectively, for US. The 11 lithiasis not detected by US were passed spontaneously (10 were <5 mm). Both techniques showed similar extraurinary pathology. Computed tomography is the most accurate technique for the detection of ureteral lithiasis; however, the combination of plain film and US is an alternative to nonenhanced CT with a lower sensitivity and radiation dose that has a good practical value.     

CT findings in patients with small bowel obstruction due to phytobezoar

The role of CT in evaluating patients with small bowel obstruction (SBO) has been extensively described in the current literature. We present the CT findings of SBO due to a phytobezoar, afterwards surgically confirmed, in 5 men and 1 woman (aged 32–89 years) out of 95 patients diagnosed by CT as having SBO in a 44-month period. These six patients underwent abdominal CT prior to operation and the CT findings were retrospectively reviewed. All six patients presented with clinical symptoms and signs of SBO; three of them had undergone gastric surgery 13, 17, and 22 years earlier, respectively. In all six cases, CT showed an ovoid intraluminal mass, 3×5 cm in size and of a mottled appearance, at the transition zone between dilated and collapsed small bowel loops. This was in contrast to feces-like material (the small bowel feces sign), seen within dilated small bowel loops in nine patients with SBO, and was typically longer. As CT is frequently performed for suspected SBO, an ovoid, short intraluminal mottled mass seen at the site of an obstruction may be regarded as a pathognomonic preoperative sign of an obstructing phytobezoar.     

Retained gauze in the sinonasal cavities: plain film and CT findings

We report a case of retained packing gauze in the right maxillary sinus following a Caldwell-Luc operation. Plain films showed total opacification of the right maxillary sinus. CT showed a mixed mesh-like soft tissue density and air in the centre of the lesion and a thick soft tissue band at the periphery of the right maxillary and ethmoid sinuses and nasal cavity.     

淀粉样变胸部影像学表现(3例报道及文献复习)

目的　进一步提高胸部淀粉样变主的影像认识。方法　搜集 3例经病理证实的淀粉样变胸部影像资料 ,3例胸部X线平片 ,2例CT扫描 ,1例心脏超声检查。结果　淀粉样变胸部影像表现有 :气管—支气管壁增厚 ,肺不张 ,少量胸腔积液 ,胸膜增厚 ,肺间质增生 ,心脏增大。结论　胸部淀粉样变影像表现结合临床可提示诊断 ,但鉴别诊断仍需依赖病理。     

High-resolution computed tomographic findings of Aspergillus infection in lung transplant patients

Objective

The aim of this study was to assess high-resolution computed tomographic (HRCT) findings at presentation in lung transplant patients diagnosed with pulmonary Aspergillus infection.

Materials and methods

We retrospectively reviewed HRCT findings from 23 patients diagnosed with pulmonary aspergillosis. Imaging studies were performed 2–5 days after the onset of symptoms. The patient sample comprised 12 men and 11 women aged 22–59 years (mean age, 43.6 years). All patients had dyspnea, tachypnea, and cough. Diagnoses were established with Platelia Aspergillus enzyme immunoassays for galactomannan antigen detection in bronchoalveolar lavage and recovery of symptoms, and HRCT findings after voriconazole treatment. The HRCT scans were reviewed independently by two observers who reached a consensus decision.

Results

The main HRCT pattern, found in 65% (n = 15) of patients, was centrilobular tree-in-bud nodules associated with bronchial thickening. This pattern was described in association with areas of consolidation and ground-glass opacities in 13% (n = 3) of patients. Consolidation and ground-glass opacities were the main pattern in 22% (n = 5) of patients. The pattern of large nodules with and without the halo sign was observed in 13% (n = 3) of patients, and were associated with consolidation and ground-glass opacities in one case.

Conclusion

The predominant HRCT findings in lung transplant patients with pulmonary aspergillosis were bilateral bronchial wall thickening and centrilobular opacities with the tree-in-bud pattern. Ground-glass opacities and/or bilateral areas of consolidation were also common findings. Pulmonary nodules with the halo sign were found in only 13% of patients.     

Skeletal coccidioidomycosis: imaging findings in 19 patients

 Objective. The objective of this study was to describe the distribution and radiologic appearance of skeletal coccidioidomycosis in 19 documented cases. Design and patients. Medical records of 19 patients (17 men, 2 women; age range 17–62 years, mean age 34 years) with clinically confirmed skeletal coccidioidomycosis were retrospectively reviewed. The patients were studied with plain radiography (n=19), skeletal scintigraphy (n=6), computed tomography (CT) (n=5), and magnetic resonance imaging (MRI) (n=1). Results. Multiple lesions were seen in 11 of 19 patients (58%). Of a total of 46 lesions, 27 (59%) were described as punched-out lytic, 10 (22%) as permeative/destructive, and 9 (17%) as involving a joint and/or disk space. Lesions were identified in almost every bone (with the exception of the facial bones, ulna, carpus, and fibula) and were most commonly found in the axial skeleton (20 of 46; 43%). Conclusion. Skeletal coccidioidomycosis is frequently multicentric and may involve almost any bone. The axial skeleton is the most common site of involvement. Lesions are usually well demarcated but may present with an ill-defined border and permeative type of bone destruction, especially in the spine. Joint involvement is not uncommon. Plain radiographs are effective in the initial evaluation of bones and joints, scintigraphic studies can identify disseminated disease, and CT and MRI are effective in determining soft tissue involvement and spinal abnormalities.     

Myoepitheliomas of the soft palate: helical CT findings in two patients.

We describe the enhancement patterns of myoepithelioma in two patients with a soft palate mass. In the first case, helical CT revealed a faintly enhancing mass. Histologically, the tumor was composed of plasmacytoid cells in a background of rich myxoid stroma. Immunostaining for CD34 showed scanty blood vessels. In the second case, helical CT revealed an intensely enhancing mass. Histologically, the mass was a cellular tumor with fibrous stroma. Immunostaining for CD34 also showed frequent blood vessels.     

The role of imaging in the diagnosis and management of thoracolumbar burst fractures: current concepts and a review of the literature

 The burst fracture of the spine was first described by Holdsworth in 1963 and redefined by Denis in 1983 as being a fracture of the anterior and middle columns of the spine with or without an associated posterior column fracture. This injury has received much attention in the literature as regards its radiological diagnosis and also its clinical managment. The purpose of this article is to review the way that imaging has been used both to diagnose the injury and to guide management. Current concepts of the stability of this fracture are presented and our experience in the use of magnetic resonance imaging in deciding treatment options is discussed.     

Acute bilateral adrenal hemorrhage due to metastatic adenocarcinoma: clinical presentation as flank pain

Adrenal metastasis is a recognized cause of bilateral adrenal hemorrhage. This condition is uncommon but potentially life threatening and usually is not diagnosed clinically before radiologic studies are performed. We discuss the case of a woman presenting to the emergency room with severe flank pain and mild anemia. Computed tomography revealed bilateral adrenal masses with hemorrhage, compatible with probable adrenal metastasis. Subsequent diagnostic work-up revealed metastatic lesions in the spine, mediastinal adenopathy, and a duodenal mass. Biopsy of the mediastinal nodes and duodenal mass each revealed metastatic adenocarcinoma of an unknown primary tumor.     

Prevalence of abnormal CT findings in patients with proven ovarian torsion and a proposed triage schema

Many women with ovarian torsion present with nonspecific abdominal/pelvic pain and initially receive computed tomography (CT). We hypothesize that the CT scans preformed on these women will all show abnormalities of the involved ovary. Our purpose is to review cases of surgically proven ovarian torsion at our institution over the last 20 years, assessing CT findings in women with ovarian torsion. A retrospective review of all patients at our institution with surgically proven ovarian torsion from 1985–2005 was conducted. Two physicians reviewed available CT reports, and a radiologist reviewed all available images. CT was obtained in 33% of the 167 patients. Dictated reports were available for 28 studies; all described an enlarged ovary, ovarian cyst, or adnexal mass of the involved ovary. Radiologist review of the available CT images confirmed these findings. This series supports the claim that a CT scan with well-visualized normal appearing ovaries rules out ovarian torsion, while abnormal pelvic findings or failure to visualize the ovaries in women with pelvic pain necessitates further evaluation of torsion. There was no extramural support for this investigation.