Abdominal aspergillosis: CT findings

Objective

In order to retrospectively evaluate the CT findings of abdominal aspergillosis in immunocompromised patients.

Materials and methods

CT scans were reviewed with regard to the sites, number, morphologic appearance, attenuation, and the contrast enhancement patterns of the lesions in six patients (5 women, 1 man; mean age, 43.4 years; range, 23-59 years) with pathologically proved abdominal aspergillosis by two gastrointestinal radiologists in consensus. Medical records were also reviewed to determine each patient's clinical status and outcome.

Results

All patients were immunocompromised state: 4 patients received immunosuppressive therapy for solid organ transplantation and 2 patients received chemotherapy for acute myeloid leukemia. Aspergillosis involved blood vessels (n = 3), liver (n = 2), spleen (n = 2), gastrointestinal tract (n = 2), native kidney (n = 1), transplanted kidney (n = 1), peritoneum (n = 1), and retroperitoneum (n = 1). CT demonstrated solid organ or bowel infarction or perforation secondary to vascular thrombosis or pseudoaneurysm, multiple low-attenuating lesions of solid organs presenting as abscesses, concentric bowel wall thickening mimicking typhlitis, or diffuse or nodular infiltration of the peritoneum and retroperitoneum.

Conclusion

Familiarity with findings commonly presenting as angioinvasive features or abscesses on CT, may facilitate the diagnosis of rare and fatal abdominal aspergillosis.     

Abdominal tuberculosis: CT evaluation

The computed tomography (CT) scans of 27 patients with abdominal tuberculosis were reviewed retrospectively to determine the range of abdominal involvement. Most patients had been at increased risk because of intravenous drug abuse, alcoholism, acquired immunodeficiency syndrome (AIDS), cirrhosis, or steroid therapy. The etiologic agent was Mycobacterium tuberculosis in 23 patients and M. avium-intracellulare in four patients with AIDS. In five patients, tuberculosis was limited to the abdomen. CT findings included adenopathy, splenomegaly, hepatomegaly, ascites, bowel involvement, pleural effusion, intrasplenic masses, and intrahepatic masses. Characteristic features were a tendency for adenopathy to prominently involve peripancreatic and mesenteric compartments, low-density centers within enlarged nodes, complex nature of the ascites, and adenopathy adjacent to sites of gastrointestinal tract involvement. Recognition of these manifestations and maintenance of an index of suspicion, especially in patients at risk, should help optimize the correct diagnosis and management of intraabdominal tuberculosis.     

Abdominal lymphadenopathy: spectrum of CT findings

Many malignant processes cause abdominal lymphadenopathy, and computed tomography (CT) has become the primary modality for its detection. Diagnosis of lymphadenopathy is facilitated by optimal imaging techniques and a knowledge of the various nodal chains, their complex interconnections, and preferential pathways of spread. Optimal techniques include imaging after oral administration of adequate amounts of barium suspension and dynamic scanning after intravenous administration of contrast material with an infusion pump. Although such techniques help prevent misdiagnoses due to normal and anomalous vascular structures, other benign diseases can mimic the CT appearance of malignant lymphadenopathy. The authors emphasize a regional approach for the diagnosis of lymphadenopathy, according to the groupings of retrocrural, retroperitoneal, gastrohepatic ligament, porta hepatis, celiac and superior mesenteric artery, pancreaticoduodenal, perisplenic, mesenteric, and pelvic lymph nodes. Lymphadenopathy is defined as retrocrural nodes greater than 6 mm in short axis, upper abdominal nodes greater than 10 mm, and pelvic nodes greater than 15 mm.     

Abdominal cystic lymphangiomas: US and CT findings

We retrospectively analyzed six cases of abdominal cystic lymphangiomas (CL), who had undergone surgical resection. These cases had been evaluated by several modalities: ultrasonography (US), computed tomography (CT), angiography and fine needle aspiration. No age predilection was found. All patients were symptomatic. The most common presenting symptoms were abdominal pain (66%), palpable mass (66%), fever (50%) and vomiting (30%). US showed septations (85%) and unicameral mass (15%); in three cases (50%) echogenic material within the cyst was found, probably due to hemorrhage and infection. CT showed capsular enhancement in all cases. Capsular and septation thickness were slightly increased in cases of infection or bleeding. At CT the contents were usually of fluid attenuation (66%); in 33% the attenuation values were higher, probably because of internal bleeding and infection. US was superior to CT in the demonstration of septations and the internal nature of the cysts. The major role of imaging is to demonstrate the cystic nature of these abdominal masses, because they do not have specific signs or symptoms that could allow a clinical diagnosis.     

Abdominal desmoids: CT findings in 25 patients.

Desmoids are histologically benign but locally aggressive fibrous tumors. Although overall they are rare lesions, they are a common manifestation of Gardner syndrome. We retrospectively reviewed clinical records and CT scans of 25 patients with abdominal desmoids. The number, location, and CT characteristics of the lesions were recorded for each patient. Tumors were solitary in 72% of patients and multiple in 28%. Fifty percent were located in the abdominal wall, 41% in the mesentery, and 9% in the retroperitoneum. More than two thirds of the lesions had well-defined borders, with the remainder displaying an infiltrative outer margin. The majority of tumors had attenuation values equal to (47%) or greater than (41%) the attenuation of muscle on contrast-enhanced CT scans. Complications attributable to the desmoid were commonly detectable on CT (hydronephrosis occurred in 36% and small-bowel obstruction in 20%). Our results detail the spectrum of CT findings and complications caused by abdominal desmoids.     

脊椎结核的CT表现

目的：探讨CT对脊椎结核的诊断价值。方法：回顾性分析52例经手术、病理证实的脊椎结核CT表现，提出诊断和鉴别诊断要点。结果：脊椎结核的主要有CT表现有：骨质破坏、骨质硬化、死骨形成和椎旁软组织肿块或脓肿。碎裂型骨质破坏和椎旁软组织肿块或脓肿是脊椎结核的典型CT表现。结论：CT能对脊椎结核做出准确的诊断与鉴别诊断。     

脊柱结核的CT表现

目的：探讨脊柱结核的CT表现。方法：对35例脊柱结核患者行CT扫描，其中有5例同时行增强扫描。结果：35例脊柱结核患者中，胸腰椎段结核18例(51．4％)；腰椎结核9例(25．7％)；胸椎结核5例(14．3％)；颈椎结核2例(5．7％)；骶椎结核1例(2．9％)。早期脊柱结核4例，仅见椎前软组织肿胀；进展期脊柱结核24例，可见椎体呈“融冰样”、“碎玻璃样”骨质破坏，破坏区内可见沙砾样死骨，增强后冷脓肿壁均一环状强化；愈合期脊柱结核7例。结论：脊柱结核在CT上有着典型的影像学表现，CT可对脊柱结核作出明确诊断。     

Abdominal CT findings in nontraumatic colorectal perforation

Colorectal perforation is an emergent medical condition in which the diagnosis and the etiology are often established on CT, the common imaging modality used for evaluating the acute abdomen. The cardinal, direct CT features suggesting perforation are extraluminal air and enteric contrast, added by secondary signs of bowel pathology, such as focal bowel wall thickening and bowel wall defect. This pictorial review will illustrate the CT findings of colorectal perforation caused by various clinical entities.     

Abdominal CT findings in small bowel perforation

Small bowel perforation is an emergent medical condition for which the diagnosis is usually not made clinically but by CT, a common imaging modality used for the diagnosis of acute abdomen. Direct CT features that suggest perforation include extraluminal air and oral contrast, which are often associated with secondary CT signs of bowel pathology. This pictorial review illustrates the CT findings of small bowel perforation caused by various clinical entities.     

Atypical presentation of pleural tuberculosis: CT findings

Contrast enhanced CT examination of a 22-year-old male with pleuritic chest pain showed pleural-based nodular thickening and masses without any parenchymal involvement or mediastinal lymphadenopathy. Pathological examination following right parietal pleural decortication showed multiple granulomas with caseation necrosis typical of tuberculosis. Pleural tuberculosis presenting with multiple pleural nodules and masses without parenchymal involvement or lymphadenopathy has, to our knowledge, never been reported in the English literature.     

Splenic involvement of tuberculosis: US and CT findings

Tuberculosis (TB) of spleen is rare and usually occurs in miliarv form. Macronodular form is extremely rare, Immunodeficiency associated with alcoholism IV drug abuse, diabetes, cancer, corticosteroid therapy, and AIDS are prominent risk factors. Early diagnosis and treatment are important, because untreated abdominal TB carries a 50% mortality rate. We report US and CT of five cases with splenic TB. Our cases showed multiple small hypoechoic and hypodense nodules on US and CT, respectively, except one case whose US was normal. All cases also had extrasplenic involvement. The diagnosis of TB was established in two cases by cervical and in one case by submandibular lymph node biopsy, in one case by peritoneal biopsy, and in one case by a typical spinal lesion at L2–3. The US and CT findings are not specific for TB, but especially in endemic regions TB should be included in the differential diagnosis of Splenic lesions. Correspondence to: U. Topal     

Intracranial tuberculosis in AIDS: CT and MRI findings

Summary CT and MRI findings in 35 patients with the acquired immune deficiency syndrome (AIDS) and proven intracranial tuberculosis (TB) are presented. Over 90% of the patients were intravenous drug abusers and in two-thrids TB was the first manifestation of AIDS. CT was normal in one quarter, the most frequent findings being hydrocephalus (51%) and meningeal enhancement (41%), commonly seen together (31.5%). Meningeal enhancement was seen in 48% of the CT studies with intravenous contrast medium and in 3 cases studied with MRI and iv gadolinium DPTA, in 2 of which CT was negative. Parenchymal involvement was found in 37% of cases; MRI was more sensitive than CT for its detection. One quarter of the patients had ischaemic lesions, mainly in the basal ganglia. We confirm the usefulness of CT and the superiority of MRI in the diagnosis of intracranial TB and in differential diagnosis from other conditions likely to be found in these patients.     

Pulmonary tuberculosis in infants: radiographic and CT findings

OBJECTIVE: As complications of tuberculosis are frequent in infancy, correct diagnosis of tuberculosis in infants is important. The purposes of this study are to summarize radiographic and CT findings of pulmonary tuberculosis in infants and to determine the radiologic features frequently seen in infants with this disease. CONCLUSION: Frequent radiologic findings of pulmonary tuberculosis in infants are mediastinal or hilar lymphadenopathy with central necrosis and air-space consolidations, especially masslike consolidations with low-attenuation areas or cavities within the consolidation. Disseminated pulmonary nodules and airway complications are also frequently detected in this age group. CT is a useful diagnostic technique in infants with tuberculosis because it can show parenchymal lesions and tuberculous lymphadenopathy better than chest radiography. CT scans can also be helpful when chest radiographs are inconclusive or complications of tuberculosis are suspected.     

成人原发型肺结核的CT表现

目的 探讨成人原发型肺结核并具有原发综合征的CT特点，提高对该病的诊断水平。方法 回顾性分析39例经临床确诊的原发型肺结核并具有原发综合征患者的CT资料，其中肺内病变局部行高分辨率CT扫描，30例行增强CT扫描。结果 肺内原发病灶位于右肺25例(64．1％)，左肺14例(35．9％)。表现为小叶实变或斑片、结节影者28例(71．8％)，扇形肺叶或肺段实变者11例(28．2％)。26例合并其他肺叶支气管播散病灶。96．3％(37例)的患者表现为多组淋巴结肿大，2R、4R和7区多见。30例增强扫描示，肿大淋巴结有4种强化方式，均匀强化10例、环行强化20例、多灶性分隔样强化18例和淋巴结破溃4例，13例有两种以上强化方式；14例可见区域淋巴结粘连成团，增强后粘连的淋巴结可有不同强化方式。结论 肺内炎症浸润合并肺门、纵隔淋巴结肿大是原发综合征的基本特征。支气管播散病灶及淋巴结强化特征有助于鉴别诊断。     

Abdominal CT findings of disseminated Mycobacterium avium-intracellulare in AIDS

Disseminated infection from Mycobacterium avium-intracellulare (MAI) has recently been recognized as a common and serious complication of the acquired immunodeficiency syndrome (AIDS). The authors report the computed tomographic (CT) findings of 17 patients with AIDS and disseminated MAI referred for abdominal CT examination. Multiple large retroperitoneal and mesenteric lymph nodes were demonstrated in 14 patients (82%). MAI involvement was confirmed within abdominal lymph nodes in six patients by fine-needle percutaneous aspiration (five patients) or postmortem examination (one patient) and within enlarged peripheral lymph nodes in two other patients. The authors concluded that large, bulky, intraabdominal adenopathy in AIDS patients should suggest the diagnosis of MAI infection as well as other known causes of adenopathy, including lymphoma and metastatic Kaposi sarcoma. The authors recommend percutaneous aspiration of enlarged intraabdominal lymph nodes to establish the correct diagnosis.     

Abdominal CT findings after liver transplantation in 66 patients

CT scanning is used frequently to assess the condition of patients after liver transplantation. The CT records of 174 adult patients who underwent liver transplantation were studied retrospectively to determine the number and timing of CT studies as well as the frequency and significance of the findings. One-hundred seventy CT scans were obtained in 66 (38%) of the 174 patients, with a mean of 2.6 scans/patient. The interval between transplantation and scanning was 1 day to 24 months; in 59 (89%) of 66 patients, the first CT scan was obtained within 30 days. The acute indications for CT scanning were fever or leukocytosis in 54 (92%) of 59 patients and abnormal liver function tests in five (8%) of 59 patients. CT scans obtained more than 30 days after transplantation were repeat scans in all but seven patients. Indications in this latter group were the same as for the acute group, plus evaluation of hepatic neoplasia in three patients. CT findings included periportal low attenuation in 41 (62%) of 66 patients; ascites in 25 (38%); splenomegaly in 19 (29%); loculated intraperitoneal noninfected fluid collections in 13 (20%); intrahepatic, splenic, pancreatic, or perihepatic abscesses in seven (11%); hepatic infarction in six (9%); splenic infarction in three (4%); and hepatic calcification in two (3%). Other major abnormalities included inferior vena caval thrombosis (one patient), pseudoaneurysm of the hepatic artery with rupture (one patient), and recurrent hepatocellular carcinoma (one patient). CT scanning after liver transplantation is used predominantly in the acute setting to evaluate for liver infarction or intraabdominal abscess. In this setting, CT showed these abnormalities, in addition to tumor recurrence or vascular abnormalities, in 15 (23%) of 66 patients.