Cytomegalovirus colitis in AIDS: radiographic findings in 11 patients

Radiographic findings in 11 proved cases of cytomegalovirus (CMV) colitis were reviewed and correlated with colonoscopic and pathologic findings. Patients were chronically ill homosexual men with multiple systemic opportunistic infections. Endoscopies showed focal or diffuse inflammation, hemorrhagic plaques, and superficial colonic ulcers. Biopsies revealed inflammatory cells associated with cytoplasmic and intranuclear inclusion bodies. Barium enema examinations showed mucosal granularity, superficial erosions, thickened folds, and spasticity. Disease was either diffuse (four patients) or segmental (two patients), or it involved the cecum exclusively (three patients). Two patients had normal barium enema studies. Computed tomography scans in two patients demonstrated marked colonic wall thickening and mucosal ulcerations. In the homosexual population with acquired immunodeficiency syndrome, CMV colitis should be part of the differential diagnosis of diffuse colitis, segmental colitis, or typhlitis.     

The radiographic findings in severe rotavirus-induced colitis

Rotavirus infections are a common cause of childhood gastroenteritis but are rarely severe enough to justify radiographs. However, there appears to be a small subset of children in whom a rotavirus-induced diarrheal illness accompanied by bloody stools is sufficiently severe and protracted to warrant barium studies. We have observed spasm and minute mucosal ulcerations of the colon in three of these children. These findings, under other circumstances, would have prompted the diagnosis of ulcerative colitis. These children also had a variety of other findings, such as osteomyelitis, intraocular mycetoma, and positive blood cultures. We suggest that when bloody diarrhea follows or accompanies a typical viral illness, rotavirus particles or antibodies be sought. This may prevent misdiagnosis of ulcerative colitis and unnecessary treatment with steroids.     

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.     

Cystic neuroblastoma in infants: radiographic and pathologic features

Cystic neuroblastoma is a rare form of neuroblastoma. Three cases of cystic neuroblastoma in the infant are reported with emphasis on the sonographic findings. In two cases, the tumor was demonstrated in the fetus. The pathologic features of the tumors are described. Development of cysts may be related to a prominent microcystic arrangement of tumor nests.     

Trisomy 21 in newborn infants: chest radiographic diagnosis

Chest radiographs of 30 infants with trisomy 21 and 881 unaffected infants were evaluated for the following findings common in trisomy 21: multiple manubrial ossification centers, 11 rib pairs, and a bell-shaped chest. Radiographs were obtained in the first 48 hours of life. Of the 881 unaffected infants, 85 (9.6%) exhibited multiple manubrial ossification centers; 46 (5.2%), 11 rib pairs; and 208 (23.6%), bell-shaped chest. Of the 30 infants with trisomy 21, 24 (80%) exhibited multiple manubrial ossification centers; ten (33%), 11 rib pairs; and 24 (80%), bell-shaped chest. The probability of trisomy 21 in routinely radiographed newborn infants is 0.05% when none of the three findings is present, 1.6% with multiple manubrial ossification centers alone, 0.2% with 11 rib pairs alone, and 0.7% with bell-shaped chest alone. The probability of trisomy 21 increases in patients with two findings and reaches 58.4% in patients with all three findings.     

Mesenteric lymphadenopathy in patient with Yersinia enterocolitica infection: a differential diagnosis to abdominal lymphoma

Summary We report a case of previously undiagnosed Yersinia enterocolitica infection in a 46-year old woman. She consulted her physician because of continual weight loss and physical lassitude. A leucocytosis was found. Sonography revealed an excessive enlargement of abdominal lymph nodes. A malignant lymphoma was suspected and the patient underwent a staging by CT. There the disease was limited on mesenteric and retroperitoneal lymph nodes. Bone marrow biopsy and CT-guided lymph node biopsy did not confirm a systemic lymphatic disease. The patient did not undergo a special therapy. After six months, CT showed a clear regression of enlarged lymph nodes. Finally, a previous Yersinia enterocolitica infection of immunotype 03 could be proved serologically. At this time, the patient had no complaints. Diagnostic and differential diagnosis of benign abdominal lymph node enlargement are discussed based on literature.      

Ultrasound and CT of multifocal liver abscesses caused by Yersinia enterocolitica

We present a patient with idiopathic liver hemochromatosis and mild secondary cirrhosis complicated by Yersinia sepsis and miliary liver abscesses proven by echography and CT.     

Exogenous lung surfactant: effect on radiographic appearance in premature infants

At birth, premature infants of 25-29 weeks gestation, at high risk for development of neonatal respiratory distress syndrome (RDS), were given a single dose (90 mg) of calf lung surfactant extract (CLSE) by intratracheal instillation. The frequency and severity of RDS were assessed with use of a simple radiographic scoring system in which pulmonary parenchymal densities and the prominence of the air-bronchogram effect were used as indicators of widespread atelectasis. Radiographs were obtained in surfactant-treated and control infants within the first 90 minutes of life as part of an initial evaluation of their pulmonary status. Subsequent examinations were performed at less than 24 hours and less than 48 hours of age. Radiographic assessment of lung disease compared consistently with coordinated data on oxygen and mean airway pressure requirements of the infants. Both indicated a significantly decreased frequency and severity of RDS in the infants treated with surfactant. The results provide supporting evidence of the effectiveness of exogenous lung surfactant replacement in mitigating RDS in very premature infants.     

Tall vertebrae at birth: a radiographic finding in flaccid infants

It has been well documented that children with severe neuromuscular disorders have tall vertebrae, presumably a consequence of altered mechanical forces. This finding was present in four neonates who were born with severe "floppy" hypotonia due to Werdnig-Hoffmann disease (two cases), nonspecific neonatal myopathy, and congenital muscular dystrophy. Fetal vertebral development is normally modified by intrauterine muscle tension and fetal activity.     

Postlobectomy chest radiographic changes: a quantitative analysis

Purpose

To provide a quantative analysis of postlobectomy chest radiographic changes and to evaluate whether the scarring from prior sternotomy affects the size of the hemithorax and the duration of air leak in patients with subsequent lobectomy.

Methods

In this retrospective case-controlled series, 10 consecutive patients who had a lobectomy after a prior sternotomy and 30 controls, 3 for each case, matched for lobectomy site were identified. Pre- and postoperative chest radiographs were quantitatively analysed for diaphragmic elevation, size of each hemithorax, mediastinal shift, and the presence of pneumothorax. Charts were reviewed for air-leak duration, surgical complications, and duration of hospitalization.

Results

There was no difference between patients with lobectomy and with and without prior sternotomy for the following variables expressed as mean (SD): hemidiaphragm elevation (1.5 ± 2.5 vs 0.5 ± 2.0 cm; P = .2), change of hemithorax size (mean transverse, 0.99 ± 0.05 vs 0.97 ± 0.07; P = .5; craniocaudal, 0.93 ± 0.08 vs 0.91 ± 0.08; P = .4) and mediastinal shift (upper, 1.2 ± 0.4 vs 1.3 ± 0.6; P = .5; lower, 1.2 ± 0.4 vs 1.2 ± 0.3; P = .8), the latter 2 were expressed as the ratio of post- to preoperative measurements. These postlobectomy radiographic findings varied, depending on the resected lobe, and became progressively more pronounced during the first 12 months after surgery. There was no difference in pneumothorax duration (mean [SD]) (9.5 ± 21 days vs 6.4 ± 7.5 days; P = .5), air leak duration (mean [SD]) (0.7 ± 0.8 days vs 1.3 ± 3.9 days; P = .6), complication rate (20% vs 30%; P = .5), or hospital stay (mean [SD]) (6.0 ± 1.7 days vs 6.9 ± 4.7 days; P = .6).

Conclusion

There are specific patterns of volume loss, mediastinal shift, and hemidiaphragm displacement that can be quantified on postlobectomy chest radiographs. Prior sternotomy did not affect postlobectomy radiographic changes or patient outcome.     

Megalocytic interstitial nephritis: ultrasonic and radiographic changes.

The radiologic and ultrasonic findings are presented in a case of megalocytic interstitial nephritis, a very rare condition, in many ways similar to renal malacoplakia. The role of ultrasound in the interpretation of the radiographic changes is discussed. Excretory urography will demonstrate a nonspecific renal mass effect and angiography may rule out evidence of tumor. Ultrasonic correlation can be highly suggestive of an interstitial parenchymal lesion.     

Ischemic colitis: serial changes in double-contrast barium enema examination

Serial double-contrast barium enema examinations were performed in 40 patients with nongangrenous ischemic colitis, 15 with the stricturing form and 25 with the transient form. Thumb-printing was observed in 30 cases (75%); it appeared within 9 days after the onset of the disease in patients with the stricturing form and within 6 days in those with the transient form. Thumb-printing disappeared about 10 days after the onset, but it lasted considerably longer in two patients with the stricturing form (21 and 29 days, respectively). Longitudinal ulcers were observed in 24 patients (60%), and healing was confirmed on day 20 or later in patients with the stricturing form and on day 9 or later in those with the transient form. Eccentric deformity was found in 19 patients (48%), sacculation in 12 (30%), and transverse ridging in five (13%). These results indicate that longitudinal ulcers and thumb-printing are both characteristic findings of ischemic colitis. The double-contrast study is useful for visualization of the ulcer.     

The radiographic changes of scleroderma in the hands

Hand radiographs from 160 patients with scleroderma were reviewed. The presence of calcinosis distal to the metacarpophalangeal joints was significantly associated with the female sex, disease duration over 10 years, digital ulceration, telangiectasia, tuft erosion and the presence of anticentromere antibodies. The presence of calcinosis proximal to the metacarpophalangeal joints was significantly associated with tuft erosions and erosions involving all joints. The lack of distal calcinosis was significantly associated with anti Scl 70 and antinucleolar antibodies. The prevalence of other radiological manifestations of scleroderma such as osteoarthritis, erosions and dorsal tuft modelling was documented. Specific radiological findings correlate with certain clinical and serological characteristics in scleroderma.