Imaging of compressive vertebral haemangiomas

Compressive vertebral haemangiomas (VHs) are rare. Correct preoperative diagnosis is useful both for operative planning (since compressive VHs are extremely vascular lesions) and to allow preoperative embolisation. Numerous radiological signs for VHs have been described, but compressive VHs frequently have atypical features. In particular, magnetic resonance features are not well established. We present imaging features in three cases of compressive VH and review the imaging findings in an additional 106 previously published cases. Findings were typical in 52 of 80 plain film (65 %), 33 of 41 computed tomography (80 %) and 13 of 25 magnetic resonance examinations (52 %). The prevalence of previously described imaging features is reported. Awareness of the range of magnetic resonance features is important since this is frequently the initial investigation in patients presenting with symptoms of neural compression. Since computed tomography is typical in 80 % of cases, this is a useful confirmatory test if magnetic resonance features are suspicious but not diagnostic of compressive VH. Received: 6 August 1999; Revised: 4 November 1999; Accepted: 4 November 1999     

Non-neoplastic intratesticular lesions mimicking tumour on ultrasound

It has recently been emphasized that the incidence of benign testicular lesions is much higher than previously suspected. Sonography is reported to have a high sensitivity but poor specificity in the evaluation of intratesticular abnormalities. This report reviews the common and unusual lesions that can mimic testicular tumour on ultrasound, and discusses the clinical and sonographic features that may help to narrow the differential diagnosis and guide management. Received: 15 August 1999; Revised: 31 January 2000; Accepted: 4 April 2000     

Various radiological appearances of angiomyolipoinas in the same kidney

A 21-year-old woman with tuberous sclerosis presented with abdominal distension and flank pain. Imaging studies, including CT and MR imaging, revealed bilateral renal mass lesions, containing fat and suggesting the diagnosis of tuberous sclerosis. However the imaging characteristics of one of these lesions differed from the others with no radiologically detectable fat tissue in this solid lesion suggesting renal cell carcinoma. Histopathological examination of this lesion in the left kidney revealed an angiomyolipoma with minimal fat tissue. The radiological diagnosis of angiomyolipomas with minimal fat tissue remains difficult and the differential diagnosis is discussed. Received: 5 October 1998; Revised: 22 December 1998; Accepted: 7 June 1999     

Ectopic localisation of adrenal cortex

We present a case of concurrence of ectopic adrenal cortex with a renal cell carcinoma. The diagnosis of the accessory adrenal tissue was made by CT-guided biopsy. With this case report, we draw attention to a specific differential diagnostic problem, policy and to the MR characteristics of ectopic adrenal cortex. Received: 10 August 1999; Revised: 21 October 1999; Accepted: 27 October 1999     

Technetium-99m hexamethylpropylene amine oxime leucocyte scintigraphy in the differential diagnosis of cerebral abscesses

The diagnosis of brain abscess is often difficult, as the clinical symptoms are not specific. Computed tomography (CT) and magnetic resonance imaging (MRI) are highly sensitive, but different cerebral lesions, especially neoplasms, can have the same ring-like contrast enhancement. Brain abscess is a severe illness requiring rapid diagnosis to choose the most appropriate therapy. Technetium-99m hexamethylpropylene amine oxime (HMPAO)-labelled leucocyte scintigraphy is commonly used to detect an inflammatory process. The aim of this study was to present the results obtained with leucocyte scintigraphy in 65 patients with intracranial mass lesions and clinical findings compatible to or suggestive of brain abscess. The final diagnosis, based on surgery, clinical findings and stereotatic puncture, was brain abscess in 17 patients, primary brain neoplasm in 22, brain metastasis in 16, lymphoma in 2, cysticercosis in 2, hematoma in 2 and cerebral infarction in 4. ^99mTc-HMPAO leucocyte scintigraphy was positive in all abscess cases. The scan was negative in the rest of the patients examined, with the exception of one lesion, which was finally diagnosed as a tumour (1 false-positive). All patients who did not have false-negative scans were treated with steroids. The sensitivity, specificity and diagnostic accuracy of leucocyte scintigraphy was 100%, 97.8% and 98.4%, respectively. In conclusion, in our experience, leucocyte scintigraphy is a valuable aid in the differential diagnosis between abscess and neoplasm. Received 25 April and in revised form 12 August 1999     

Rare complication of intestinal Crohn's disease: giant fibroid polyp

A 25-year-old male patient who had a brother with Crohn's disease was referred to our clinic with bloody diarrhea and crampy abdominal pain. After a plain erect abdominal X-ray, enteroclysis was performed, followed by abdominopelvic CT. Besides the radiological features of CD, both enteroclysis and CT revealed a big polypoid filling defect in the small intestine. The patient was surgically treated and the histopathology of the specimen revealed a giant fibroid polyp superimposed on CD, an extremely rare complication heretofore unmentioned in the radiology literature. In this report we discuss the role of enteroclysis in the diagnosis of complicated cases of long-standing CD. In addition, we also shed light on the importance of both enteroclysis and CT, with their complementary findings, in the radiological diagnosis of rare complicated cases of CD. Received: 20 May 1998; Revision received: 29 December 1998; Accepted: 21 June 1999     

Role of radiology in the diagnosis of neurosarcoidosis

Clinical studies report a rate of 5 % and autopsy results a rate of 25 % of brain involvement in sarcoidosis. The aim of this study was to evaluate the role of radiology in the diagnosis of patients with neurosarcoidosis. The chest radiographs and MRI brain scans of 22 patients with sarcoidosis were retrospectively reviewed, along with the information that was provided in the request form and clinical charts. All patients had neurological signs and symptoms; 21 patients were examined with contrast enhancement. Facial nerve paralysis was the most common clinical manifestation identified in 10 patients. A wide spectrum of MR findings was noted: periventricular high-signal lesions on T2-weighted images (46 %); multiple supratentorial and infratentorial brain lesions (36 %); solitary intra-axial mass (9 %); solitary extra-axial mass (5 %); and leptomeningeal enhancement (36 %). Neurological signs and symptoms can be significant manifestations of sarcoidosis. Magnetic resonance imaging shows a wide spectrum of brain abnormalities associated with neurosarcoidosis. The patient's history and chest X-ray are helpful in arriving at the correct diagnosis, but in selected cases with isolated brain involvement biopsy may still be required. Received: 21 June 1999; Revised: 27 August 1999; Accepted: 15 October 1999     

A vascular sarcoid mass mimicking a convexity meningioma

We report a 48-year-old woman with a left posterior temporal extra-axial mass that had the imaging characteristics of a meningioma on preoperative CT, MRI and angiography. However, a biopsy diagnosis of sarcoidosis was made. This case illustrates that dural-based sarcoid masses can be very vascular and radiographically indistinguishable from meningiomas. Characteristic imaging features of extra- and intra-axial sarcoid lesions are discussed. Received: 4 March 1999/Accepted: 11 June 1999     

Spinal cord magnetic resonance imaging in suspected multiple sclerosis

We examined the value of spinal cord magnetic resonance imaging (MRI) in the diagnostic work-up of multiple sclerosis (MS). Forty patients suspected of having MS were examined within 24 months after the start of symptoms. Disability was assessed, and symptoms were categorized as either brain or spinal cord. Work-up further included cerebrospinal fluid analysis and standard proton-density, T2-, and T1-weighted gadolinium-enhanced brain and spinal cord MRI. Patients were categorized as either clinically definite MS (n = 13), laboratory-supported definite MS (n = 14), or clinically probable MS (n = 4); four patients had clinically probable MS, and in nine MS was suspected. Spinal cord abnormalities were found in 35 of 40 patients (87.5 %), consisting of focal lesions in 31, only diffuse abnormalities in two, and both in two. Asymptomatic spinal cord lesions occurred in six patients. All patients with diffuse spinal cord abnormality had clear spinal cord symptoms and a primary progressive disease course. In clinically definite MS, the inclusion of spinal imaging increased the sensitivity of MRI to 100 %. Seven patients without a definite diagnosis had clinically isolated syndromes involving the spinal cord. Brain MRI was inconclusive, while all had focal spinal cord lesions which explained symptoms and ruled out other causes. Two other patients had atypical brain abnormalities suggesting ischemic/vascular disease. No spinal cord abnormalities were found, and during follow-up MS was ruled out. Spinal cord abnormalities are common in suspected MS, and may occur asymptomatic. Although diagnostic classification is seldom changed, spinal cord imaging increases diagnostic sensitivity of MRI in patients with suspected MS. In addition, patients with primary progressive MS may possibly be earlier diagnosed. Finally, differentiation with atypical lesions may be improved. Received: 21 April 1999; Revised: 3 August 1999; Accepted: 7 August 1999     

Aberrant cervical thymus in an infant: an unusual cause of stridor

We report an 8-month-old infant presenting with stridor caused by a nonpalpable neck mass discovered at imaging and surgery. The diagnosis of aberrant thymic tissue was confirmed at histopathology. The authors reviewed the literature and discuss the embryology, imaging findings and differential diagnosis of this rare disorder. Received: 1 July 1999; Revised: 3 September 1999; Accepted: 6 September 1999     

MR diagnosis of a congenital abnormality of the thoracic aorta with an aneurysm of the right subclavian artery presenting as a Horner's syndrome in an adult

Congenital abnormality of the aortic arch is a diagnosis made most of the time incidentally in childhood, unless dysphagia or respiratory disorders occur before. A case of a complex aortic arch anomaly with an aneurysm of the right subclavian artery presenting as an isolated Horner's syndrome in an adult is reported herein. Magnetic resonance imaging led to this very unusual diagnosis. Received: 17 March 1999; Revised: 15 July 1999; Accepted: 13 August 1999     

Pelvic digit: an uncommon developmental anomaly

The radiological features of seven cases of pelvic digit discovered incidentally on plain radiographs are described and differentiation from other causes of new bone formation is discussed. Its recognition as a benign anomaly is important to avoid unnecessary investigation or intervention. An embryological theory of development of pelvic digit is proposed. Received: 18 November 1998; Revised: 9 March 1999; Accepted: 7 May 1999     

Post-Paget telangiectatic osteosarcoma of the skull

Sarcomatous transformation is the most dreaded complication of Paget’s disease. We report on a case of post-Paget telangiectatic osteosarcoma of the skull, a variant of osteogenic osteosarcoma, in a 79-year-old woman. We discuss the radiological pattern in relationship to the differential diagnosis. Received: 27 July 1998 Revision requested: 24 August 1998, 23 December 1998 Revision received: 25 November 1998, 12 April 1999 Accepted: 13 April 1999     

Chondromyxoid fibroma of the temporal bone: CT and MRI findings

We present the case of a 44-year-old woman with chondromyxoid fibroma of temporal bone origin. Since this is the least common bone tumor of cartilaginous origin, it is highly unusual to find this tumor in the skull. In fact, the literature describes 18 cases of this form of neoplasia arising in the skull, only 4 of these having originated in the temporal bone. To date, the radiological features of these tumors, and especially features detected using the latest imaging modalities, have not been described in detail. This report is unique in that it is the first to present a case of chondromyxoid fibroma of the temporal bone accompanied by detailed CT and MRI findings. Received: 8 July 1999; Revised: 14 December 1999; Accepted: 20 December 1999     

Uptake of 111In-pentetreotide and 99mTc-labeled autologous granulocytes in Kimura’s disease

Uptake of ¹¹¹In-pentetreotide (OctreoScan) and ^{99 m}Tc-labeled autologous granulocytes by the lesions of a 37-year-old female from Thailand with Kimura's disease is described. This is a benign chronic inflammatory condition that is endemic in Asians. It is characterized by adenopathy and subcutaneous nodules mostly affecting the head and neck area or the salivary glands. Although these examinations have previously not been described in Kimura's disease, uptake of the radiopharmaceuticals in the lesions can be expected from their histological appearance. With increasing medical, social and economic interactions with Asia, it is important to recognize this cause of adenopathy, including its appearance at various nuclear medicine examinations. Received: 11 February 1999; Revised: 20 July 1999; Accepted: 6 August 1999     

Bilateral xanthogranulomatous perinephritis without renal parenchymal involvement

A case of isolated bilateral xanthogranulomatous perinephritis, which presented as a symmetrical irregular perirenal rim of soft tissue, is reported. Differential diagnosis and image features on ultrasound, computed tomography, and magnetic resonance are discussed. Received: 20 May 1999; Revised: 20 July 1999; Accepted: 22 July 1999     

Evaluation of CT findings for diagnosis of pleural effusions

Computed tomography studies are usually used to assess patients with pleural effusions, and radiologists should be aware of the significance of different CT findings for the diagnosis of the effusion. The purpose of this study was to evaluate CT findings for etiological diagnosis of pleural effusions. Contrast-enhanced CT of the chest of 211 patients with pleural effusion of definite diagnosis were evaluated. The CT images were evaluated for the presence and extent of pleural effusion, thickening or nodules, extrapleural fat and other changes in the mediastinum or lung. The CT scans were read by two independent observers and correlation between them was evaluated. Comparison of CT findings between benign and malignant effusions, between exudates and transudates, and between empyemas and the other parapneumonic effusions were carried out. Kappa values for most CT findings were > 0.85. Loculation, pleural thickening, pleural nodules, and extrapleural fat of increased density were only present in exudative effusions. Multiple pleural nodules and nodular pleural thickening were the only pleural findings limited to malignant pleural effusions. The signs were also more frequently seen in empyemas than in other parapneumonic effusions. Computed tomography findings can help to distinguish between transudates and exudates. Although there is some overlap between benign and malignant pleural effusions, pleural nodules and nodular pleural thickening were present almost exclusively in the latter. Although differences between CT findings of empyemas and the other parapneumonic effusions exist, there is no finding which can definitely differentiate between them. Received: 27 January 1999; Revised: 24 June 1999; Accepted: 24 August 1999     

Meningeal hemangiopericytoma in childhood

Meningeal hemangiopericytoma (MHP) is extremely rare in childhood. Mean age at diagnosis is between 38 and 43 years. We present an 8-year-old boy with MHP of the middle cranial fossa. Imaging findings were indistinguishable from an aggressive bone tumor such as Ewing's sarcoma. Imaging findings are presented and discussed. Our case indicates that MHP should be considered in the differential diagnosis of skull-base tumors despite the fact that MHP is extremely rare in childhood. Received: 8 July 1999; Revised: 28 September 1999; Accepted: 29 September 1999     

Abdominal wall hernias: imaging with spiral CT

Computed tomography is an accurate method of identifying the various types of abdominal wall hernias, especially if they are clinically occult, and of distinguishing them from other diseases such as hematomas, abscesses and neoplasia. In this study we examined the CT images of 94 patients affected by abdominal wall hernias observed over a period of 6 years. Computed tomography clearly demonstrates the anatomical site of the hernial sac, the content and any occlusive bowel complications due to incarceration or strangulation. Clinical diagnosis of external hernias is particularly difficult in obese patients or in those with laparotic scars. In these cases abdominal imaging is essential for a correct preoperative diagnosis and to determine the most effective treatment. Received: 20 May 1999; Revised: 10 August 1999; Accepted: 13 August 1999     

Appendicitis after appendectomy: CT diagnosis

This article presents a case of appendicitis 7 years after open appendectomy. Together with the apparent CT findings we discuss the current literature of this issue. Received: 21 April 1999; Revised: 11 August 1999; Accepted: 13 August 1999