Computed tomography in the evaluation of diverticulitis

Computed tomography (CT) was performed in 43 cases of colonic diverticulitis and compared with the contrast-enema examination (CE) in 37 patients. Findings on CT included inflammation of the pericolic fat in 98% of cases, diverticula in 84%, thickening of the colon wall in 70%, a pericolic abscess in 35%, peritonitis in 16%, a fistula in 14%, colon obstruction in 12%, and intramural sinus tracts in 9%. Secondary findings included a distant abscess in 12% and ureteral obstruction in 7%. In addition to detecting ureteral and bladder involvement and distant abscess formation, CT was preferable for demonstrating the extent of pericolic inflammation, which was underestimated with CE in 41% of patients. Differential diagnosis of the CT findings is discussed. The authors indicate that CT should be the initial procedure in patients with suspected diverticulitis, particularly when CE is contraindicated.     

Computed tomography findings in the Swyer-James syndrome

A case of hyperlucent lung, the Swyer-James syndrome, diagnosed by computed tomography (CT) scan is presented. The CT findings and the role of this modality in establishing the diagnosis are discussed.     

Computed tomography of Sipple syndrome

The computed tomographic (CT) findings of pheochromocytoma, adrenal medullary hyperplasia, and medullary thyroid carcinoma in a patient with Sipple syndrome are presented. The CT finding of diffuse enlargement of one or both adrenal glands in a patient with clinical and laboratory evidence of pheochromocytoma should raise the suspicion of adrenal medullary hyperplasia and Sipple syndrome.     

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.     

Computed tomography in the evaluation of renal lymphoma

Four patients with renal lymphoma were evaluated by computed tomography and presented the following different manifestations: (a) multiple large and small nodules infiltrating each kidney; (b) a single large renal mass extending into the perirenal space; (c) diffuse infiltration of both kidneys; and (d) lesion of the renal hilus encasing the renal pelvis and proximal ureter of one kidney. Computed tomography is a sensitive, noninvasive imaging modality that should be performed early in the course of disease in patients with known or suspected lymphoma.     

Computed tomography in the evaluation of Crohn disease

The abdominal and pelvic computed tomographic examinations in 28 patients with Crohn disease were analyzed and correlated with conventional barium studies, sinograms, and surgical findings. Mucosal abnormalities such as aphthous lesions, pseudopolyps, and ulcerations were only imaged by conventional techniques. Computed tomography proved superior in demonstrating the mural, serosal, and mesenteric abnormalities such as bowel wall thickening (82%), fibrofatty proliferation of mesenteric fat (39%), mesenteric abscess (25%), inflammatory reaction of the mesentery (14%), and mesenteric lymphadenopathy (18%). Computed tomography was most useful clinically in defining the nature of mass effects, separation, or displacement of small bowel segments seen on small bowel series. Although conventional barium studies remain the initial diagnostic procedure in evaluating Crohn disease, computed tomography can be a useful adjunct in resolving difficult clinical and radiologic diagnostic problems.     

Computed tomography in the evaluation of musculoskeletal neoplasms

In a study of 62 musculoskeletal neoplasms, computed tomography contributed little to establishing tissue diagnosis. Its primary value lay in the assessment of intraosseous and/or extraosseous extent of disease. CT also established the presence or absence of disease in a small number of cases with clinically questionable findings. In most cases, conventional radiographic methods were superior in diagnosing musculoskeletal neoplasms.     

Computed tomography in the evaluation of orbital fractures

Orbital fractures should be evaluated by CT in frontal and transverse planes. The significance of blow-out floor and medial wall fractures is discussed. Limitation of inferior rectus muscle mobility is thought to be a result of edema, enophthalmos, fat prolapse or scar tissue formation, rather than muscle incarceration. The consequent therapeutic attitude implies a rigorous preoperative exploration by CT or for some orbital floor fractures by MR.     

Computed tomography of the superior and inferior ankle joint]

Computed tomography of the tibotalar and subtaler joints in standardised planes produces comparable images irrespective of examiners. Traumatic, degenerative or neoplastic lesions of the joint surfaces are shown without superimposition. Intraosseous changes can be localised exactly in relation to the joint. Assessment of possible fractures in children is simplified by simultaneous imaging of soft tissues and bone. Diagnosis of traumatic lesions of ligaments or tendons and dislocation of tendons by bone fragments is possible only on CT-images. After injection of air loose intra-articular bodies can be recognised much more satisfactorily with computed tomography than with conventional arthrography.     

Computed tomography in the evaluation of thyroid disease

Traditionally, thyroid imaging has been performed primarily using radionuclide scanning. High-resolution computed tomography (CT) was performed in 18 patients to evaluate the CT appearance of various thyroid abnormalities including diffuse toxic goiter, multinodular goiter, Hashimoto thyroiditis, thyroid adenoma, and malignant thyroid tumors. CT images of the thyroid were correlated with radionuclide scanning, surgical findings, and clinical and laboratory results. CT provided a complementary method for evaluation of the thyroid by defining the morphology of the thyroid gland and more precisely defining the anatomic extent of thyroid abnormalities in relation to the normal structures of the neck and mediastinum.