Cerebral hydatid disease

Although hydatid disease of the liver and lungs is common in South Asia, involvement of the brain is relatively rare. Two cases of cerebral echinococcosis are presented. One case involved the brain, kidney, heart and spleen. The case is unusual because of the multiplicity of intracranial lesions and sparing of the liver and lungs. The other case is a classical cerebral hydatid cyst. Both cases were confirmed histologically.     

Orbital hydatid cysts: Sonographic and CT appearance

Two cases of unilateral proptosis due to orbital hydatid cysts were evaluated by ultrasound and computed tomography. Image morphology of this rare disease is presented.     

CT appearances of rounded atelectasis

Five patients examined with CT bad lesions fulfilling criteria for a diagnosis of rounded atelectasis (RA) and these were managed with out biopsy. In three patients unsuspected contralateral lesions were identifled as RA variants, and one of these was biopsied at thoracotomy and proved to be benign. All patients remain well at 6–22 months follow-up. We concur with recent reports that there is a spectrum of CT appearances of RA and that even atypical lesions seldom need further investigation. We also suggest that the appearances of some atypical lesions add support for the fibrosing theory of pathogenesis of RA.     

Vertebral hydatid disease

Hydatid disease affecting the bones is a rare condition, its incidence ranging from 0.5-2% of all cases of hydatidosis. The bones most often involved are the vertebrae (44%). A 22-year-old man presented to the hospital with low back pain. A CT scan revealed intracanal and paravertebral cystic lesions at the level of L5-S1 with destruction of the corpus and lamina, and sacral foramen invasion. An operation was performed and histopathological findings confirmed the diagnosis. In countries where hydatidosis is endemic, the possibility of the disease must be borne in mind.     

Cardiac hydatid disease: Report of two cases

Cardiac involvement in hydatid disease is rare, occurring in less than 2% of cases of hydatid infection. It can occur as part of a widespread systemic infection or as an isolated event. It may be asymptomatic for a long period before presenting with a myriad of non‐specific symptoms. Imaging plays an important role in the diagnosis, surgical planning and follow up of cases. Current treatment involves attempted surgical resection (cystopericystectomy) with long‐term follow‐up chemotherapy (Albendazole). Both the disease and its surgical treatment carry a high complication rate, including rupture leading to anaphylaxis and death.     

Haemobilia – a rare presentation of intrabiliary hydatid disease

Intrabiliary hydatid cysts have been known to cause complications. We report a rare case of calcified crumpled intrabiliary hydatid cyst causing massive haemobilia due to a hepatic artery pseudoaneurysm, an unusual complication of intrabiliary hydatid cyst. The patient was successfully treated by stenting of the pseudoaneurysm with overlapping stents.     

Pulmonary hydatid disease mimicking sequestration: Differentiation on magnetic resonance imaging

A case of hydatid disease of the lung proven by thoracotomy and histopathological evaluation is described. It was clinically and radiologically suggestive of a complicated pulmonary sequestration or non-resolving consolidation.     

Primary multiple hydatid cysts of the brain

Primary hydatid cyst of the brain in adults is rare and can pose various diagnostic problems. Multiplicity of these cysts is even rarer. The most important diagnostic tool is computed tomography scanning of the brain. Hydatid cyst should be included in the differential diagnosis when a cystic brain lesion is found in patients from an endemic echinococcosis area.     

Mucinous cystadenoma of the appendix with unusual sonographic appearances

A case of an appendiceal cystadenoma resulting in a large mucocele in a 35 year old man presenting with abdominal pain is reported. On ultrasonography, an unusual appearance of strand-like layers of varying echotexture suggesting a solid lesion was seen. On computed tomography, calcification and contrast enhancement of the rim was noted. The spectrum of imaging appearances of appendix mucoceles is reviewed.     

Unusual computed tomography appearances of acute cholangitis

This case describes some unusual computed tomography findings in a patient with an acute ascending cholangitis and pancreatitis due to a calculus impacted in the distal common bile duct.     

Comparison of two imaging protocols for acute stroke: Unenhanced cranial CT versus a multimodality cranial CT protocol with perfusion imaging

The aim of the study was to validate a multimodality cranial computed tomography (CCT) protocol for patients with acute stroke in the United Arab Emirates as a basic imaging procedure for a stroke unit. Therefore, a comparative study was conducted between two groups: retrospective, historical group 1 with early unenhanced CCT and prospective group 2 undergoing a multimodality CCT protocol. Follow‐up unenhanced CCT >48 h served as gold standard in both groups. Group 1: Early unenhanced CCT of 50 patients were evaluated retrospectively, using Alberta Stroke Program Early CT Score, and compared with the definite infarction on follow‐up CCT. Group 2: 50 patients underwent multimodality CCT (unenhanced CCT, perfusion studies: cerebral blood flow, cerebral blood volume, mean transit time and CT angiography) <8 h after clinical onset and follow‐up studies. Modified National Institute of Health Stroke Scale was used clinically in both groups. Group 1 showed 38 men, 12 women, clinical onset 2–8 h before CCT and modified National Institute of Health Stroke Scale 0–28. Group 2 included 38 men, 12 women, onset 3–8 h before CCT, modified National Institute of Health Stroke Scale 0–28. Sensitivity was 58.3% in group 1 and 84.2% in group 2. Computed tomography angiography detected nine intracranial occlusions/stenoses. The higher sensitivity of the multimodality CCT protocol justifies its use as a basic diagnostic tool for the set‐up of a first‐stroke unit in the United Arab Emirates.     

Ultrasound and computed tomography appearances of primary hepatic leiomyosarcoma

Primary hepatic leiomyosarcoma is a rare condition. The ultrasound and computed tomography findings in a 73 year old female patient are described. Previous reports have concentrated on the histopathological features and clinical presentation of the condition.     

Non‐vascular intervention with real‐time CT fluoroscopy

The emerging technology of CT fluoroscopy (CTF) represents the first opportunity for real‐time CT guidance in non‐vascular intervention. As with any new technology, its efficacy requires validation before widespread application can be advocated. A review of our initial experience is presented with particular attention to room, procedure and fluoroscopy time savings, complication rates and dosimetry. Computed tomography fluoroscopy is useful for pulmonary, pelvic, retroperitoneal and other deep organ lesions that are not easily accessible by other modalities. Computed tomography fluoroscopy decreases procedure time by at least a factor of 2 compared with conventional CT (C‐CT) guidance, resulting in improved throughput in a busy interventional CT department. Accurate targeting of small lesions, previously considered inaccessible, can also be achieved with CTF. Exposure to the physician’s hands can be reduced to a level that is acceptable to the International Commission on Radiological Protection guidelines.     

嗅神经母细胞瘤的CT表现

目的探讨CT在嗅神经母细胞瘤的诊断和分期中的价值。方法回顾性分析15例嗅神经母细胞瘤的CT表现。男10例,女5例。平扫8例,增强扫描7例。结果肿瘤中心位于筛窦10例,鼻腔5例;9例呈膨胀性生长,6例浸润性生长,侵犯范围为鼻腔及筛窦各14例,眼眶及上颌窦各9例,蝶窦、额窦、脑实质及鼻咽各3例,海绵窦及颞下窝各1例。14例伴有相邻骨质破坏。7例增强扫描中,轻度强化4例,中度强化3例,1例出现钙化。结论CT扫描可清楚显示肿瘤大小与部位,冠状面及矢状面扫描能更好地显示侵犯范围,具有重要意义。     

Aggressive hydatid disease of the foot and ankle

An extremely rare case of aggressive hydatid disease of bone is described in a 29-year-old male. Although the disease was limited to the talus at initial presentation, it spread through the entire foot and ankle after surgical treatment. The unusual aggressive nature of the recurrence was attributed to the spread of infestation during the first surgery. Amputation of the foot and ankle was performed due to the invasive nature of the bone and soft tissue involvement.     

Magnetic resonance imaging signal characteristics in hydatid cysts

The MRI features of hydatid cysts were retrospectively studied in 12 patients to look for specific signal characteristics. Twelve patients in the series included eight with abdominal, two with abdominal‐pelvic, one with a sacral and one with a lung hydatid cyst. The T1‐, T2‐ and proton density (PD)‐weighted images of spin‐echo sequence were used for imaging. The signal characteristics of the hydatid parent cyst capsule and fluid, daughter cyst fluid, detached germinal membrane and surrounding soft tissue reaction were noted. Observations revealed that the capsule is best seen on T2‐ and PD‐weighted images. The daughter cysts are best demonstrated on T1‐weighted images, whereas the difference in the signal intensities of parent cyst and daughter cyst fluid is better demonstrated on T2‐weighted and T1‐weighted images, and the detached germinal membrane is best seen on T2‐ and PD‐weighted images. The signal characteristics of hydatid cyst morphology can help distinguish it from other entities.     

Retrobulbar hydatid cyst: Assessment of two cases

A 54-year-old man with a unilocular hydatid cyst within the infero-posterior angle of the orbit and a 6-year-old male child with a unilocular hydatid cyst within the supero-medial angle of the orbit are presented. The retrobulbar cysts were diagnosed with computed tomography and ultrasonography and were treated after serologic confirmation.     

Atrial septal defects: Magnetic resonance and computed tomography appearances

Atrial septal defects are associated with significant morbidity and mortality. Echocardiography is the first‐line imaging modality, but MR and CT imaging can provide complimentary information, especially for the detection of associated anomalies and for assessing changes in the pulmonary vasculature. The aim of this pictorial essay is to review the spectrum of atrial septal defects, with particular reference to their cross‐sectional imaging appearances and issues pertaining to management.     

Richter's hernia of the splenic flexure: Computed tomography appearances

A case of a clinically occult Richter's hernia of the splenic flexure, through an anterior abdominal wall defect, is described. In view of the initial absence of bowel obstruction with a partial or Richter's hernia, and in the absence of physical findings, the importance of computed tomography (CT) in demonstrating abdominal wall lesions is highlighted.