The computed tomographic spectrum of thoracic sarcoidosis

Thoracic manifestations of sarcoidosis are well recognized on conventional radiographs. Less well known are the CT appearances of sarcoidosis. This article reviews the spectrum of CT findings in sarcoidosis; highlighting distributions of lymphadenopathy on CT, patterns of parenchymal involvement, and pulmonary complications of sarcoidosis as demonstrated by CT.     

Seminal vesicle abscesses: spectrum of computed tomographic findings

The computed tomographic (CT) findings in four cases of seminal vesicle abscess are presented. The predominant infectious organism in two cases was Escherichia coli, one case was probably caused by Mycobacterium tuberculosis, and another by atypical mycobacterium. The CT findings included unilateral (three cases) or bilateral involvement (one case), seminal vesicle enlargement with hypodense areas within the gland (three cases), adjacent perivesicle inflammation (three cases), and associated bladder wall thickening (three cases). Although the diagnosis of seminal vesicle abscess is often overlooked clinically, CT may help suggest the correct diagnosis early thereby helping to initiate therapy.     

The crazy-paving pattern in granulomatous mycosis fungoides: high-resolution computed tomography-pathological correlation

The purpose of this report is to describe a further distinctive cause of crazy-paving pattern on thin-section computed tomography in a patient affected by pulmonary granulomatous mycosis fungoides. It was possible to reconcile the crazy-paving appearance on thin-section computed tomography scan with the histopathologic pattern termed acute fibrinous organizing pneumonia pattern.     

Vertical fissure: computed tomographic observation and correlation with chest radiography

Purpose The purpose of this study was to assess radiographic and computed tomography (CT) findings of the vertical fissure. Materials and methods We assessed whether the vertical fissures appeared as a fine linear shadow or as a linear edge with lateral opacity and medial lucency on chest radiographs. The CT scans were evaluated for the presence of volume loss in the lower lobes and for the presence of a portion of the fissure that is orientated tangential to the X-ray beam. Results We observed vertical fissures in six patients. CT studies revealed volume loss in the lower lobes in all patients and showed the presence of a portion of the fissure that is orientated tangential to the X-ray beam in only two patients whose vertical fissures were not associated with lateral opacity and medial lucency on chest radiographs. Conclusion We believe that the vertical fissure is closely related to volume loss in the lower lobe and represents the edge of the anterobasal segment of a major fissure or a portion of the fissure that is orientated tangential to the X-ray beam, with or without lateral opacity and medial lucency.     

Bilateral ectopic pheochromocytomas: computed tomographic and sonographic correlation

We describe a case of clinically unsuspected bilateral ectopic pheochromocytomas in a young woman. The bilateral retroperitoneal masses were located in the lower sympathetic ganglia at the level of the organ of Zuckerlandl. Computed tomography (CT) accurately identified the location and vascular characteristics of these neoplasms and provided access for percutaneous biopsy. Sonographic correlation is also presented.     

Acute small bowel ischemia: spectrum of computed tomographic findings

Acute small bowel ischemia is an important clinical entity with significant morbidity and mortality. Since the clinical presentation is often nonspecific, abdominal computed tomography (CT) is frequently obtained for the evaluation of patients with equivocal or unsuspected intestinal ischemia. In this article, the direct and ancillary CT findings of acute small bowel ischemia are reviewed. Although the individual CT manifestations are rarely specific, awareness of the spectrum of CT findings of small intestinal ischemia can help to suggest the diagnosis and direct appropriate management.     

Magnetization transfer MR imaging correlation with histopathology in intracranial tuberculomas

OBJECTIVE: The purpose of this study was to correlate the differences in the magnetization transfer (MT) ratios of different components of the tuberculoma with histopathology and to see whether MT or conventional MR imaging correlates better with histopathology. METHODS: MT T1 and conventional spin echo MR imaging was performed in six patients with intracranial tuberculomas. The tuberculomas were excised as a single mass and ex vivo MR imaging was performed using the same protocol. The gross histopathology was compared with in vivo imaging with respect to the MR signal intensity (MT ratio) in all six specimens. RESULTS: The size of the tuberculomas was larger on MT T1-weighted images compared to T2-weighted images and matched the gross measurements of each specimen. The MT hyperintense rim matched the cellular component of the tuberculoma that was masked on T2-weighted images because of the associated perifocal oedema. The cellular component had a lower MT ratio compared to the necrotic components. CONCLUSION: The outer hyperintense rim and hyperintense strands are due to the cellular infiltrate, noncaseating granulomas, and gliosis while the hypointense core represents solid caseation. The cellular outer rim shows lower MT ratio compared to the core of the tuberculoma. Histological correlation of the cellular and necrotic components of tuberculomas is best shown with MT T1 imaging.     

Agenesis of an internal carotid artery: Angiographic,tomographic and computed tomographic correlation

Summary Congenital absence of one internal carotid artery was found by angiography in a woman of 52 years who had subarachnoid hemorrhage. The absence of the bony carotid canal on the affected side substantiated the congenital nature of this rare vascular anomaly. We believe this to be the first report of absence of the bony carotid canal and the intracavernous portion of the internal carotid artery confirmed by computed tomography and cavernous sinography.     

Subdural hematoma secondary to ruptured intracranial aneurysm: computed tomographic diagnosis

This case report illustrates a cerebral aneurysm that bled into the subdural space without any clinical or radiographic evidence of subarachnoid hemorrhage. Both the aneurysm and the subdural hematoma were easily demonstrated on computed tomography scan. The incidence of of this lesion and possible etiology are discussed.     

Microcystic adenoma of the pancreas: spectrum of computed tomographic findings

Fourteen cases of microcystic adenoma (serous cystadenoma) of the pancreas were reviewed and radiological findings were correlated with pathological specimens. Microcystic adenomas appeared grossly either as solid tumors with innumerable tiny cysts or as honeycombed cystic tumors depending on the size and number of cysts and amount of connective tissue. Dynamic enhanced CT of the tumor reflected the amount of connective tissue and appeared as (a) densely enhanced spongy masses (n = 6: classic appearance); (b) cystic masses with (n = 6) or without (n = 1) enhanced septa; or (c) dense diffusely enhanced mass (n = 1). Ultrasound similarly showed a variety of features such as echogenic masses with or without small cystic portions, multilocular cysts, or mixed hyperechoic and hypoechoic masses. The ultrasonic features mainly reflected the dominant sizes of cysts. Angiography almost always showed inhomogeneously hypervascular masses with tumor vessels. The imaging diagnosis is easy and conclusive in classic subtypes, but a correct diagnosis can be made even in other subtypes. However, mucinous cystic neoplasm can be confused with microcystic adenoma with large cysts and a small amount of connective tissue, and islet cell tumors can be mistaken for microcystic tumors with minute cysts.     

Gastric true leiomyoma: computed tomographic findings and pathological correlation

OBJECTIVE: This study describes the computed tomographic (CT) findings of true leiomyomas in the stomach. METHODS: Eleven patients with histopathologically proven gastric true leiomyomas were finally enrolled. All cases were CD117 (c-kit) negative on immunohistochemical study. We retrospectively reviewed the CT findings of gastric true leiomyomas for the following considerations: location, morphological features (size, contour, tumor growth pattern, and enhancement pattern), and ancillary findings (ulceration and calcification). RESULTS: All leiomyomas were in the cardia, with an average tumor size of 36 mm (range, 13-47 mm). Computed tomography scans revealed the morphological features as follows: tumor growth pattern: intraluminal mass (n = 10) and extraluminal masses (n = 1); contour: lobulated margin (n = 7) or smooth margin (n = 4). All lesions showed homogeneous contrast enhancement. Most of the tumors showed lower enhancement than those in the liver (n = 10). One case showed ulceration but no calcification. CONCLUSIONS: In conclusion, gastric leiomyomas are mainly located in the cardia and usually appeared as homogenous low attenuated masses on computed tomography.     

Fibrovascular polyp of the esophagus with computed tomographic and pathological correlation

The authors report a patient with a fibrovascular polyp of the esophagus. Radiologic and pathological features of this rare tumor include computed tomographic findings of a lesion of low density, situated intraluminally so that the findings may be relatively specific.     

Ultrasmall intrapulmonary lymph node: usual high-resolution computed tomographic findings with histopathologic correlation

OBJECTIVE: To clarify high-resolution computed tomographic findings of ultrasmall intrapulmonary lymph node (IPLN) with histopathologic correlation. METHODS: Fourteen IPLNs 3 to 6 mm in diameter were identified in 7 lobectomy specimens. Preoperative multidetector-row, high-resolution computed tomography covering the whole lobe was evaluated and compared with histopathologic findings. RESULTS: Thirteen of 14 nodules appeared as well-defined solid nodules. The shape was polygonal or angular in 11 and round or oval in 3. Thirteen of 14 nodules were located within 15 mm of pleura. All 11 nodules apart from pleura were accompanied with linear opacity contiguous with pleura. Ten of 14 nodules were adjacent to peripheral pulmonary veins, and 4 were adjacent to linear opacity from pulmonary veins. These findings were confirmed pathologically, and linear opacities were consistent with thickened or normal interlobular septa. CONCLUSIONS: Ultrasmall IPLN has usual high-resolution computed tomographic findings reflecting histopathologic findings.     

Hepatoid adenocarcinoma: computed tomographic imaging findings with histopathologic correlation in 6 cases

OBJECTIVE: Hepatoid adenocarcinoma (HAC) is a special type of primary tumor with aberrant hepatocellular differentiation occurring in extrahepatic organs. Our objective was to review the computed tomographic findings of HAC and to correlate the imaging features with histopathologic findings. Institutional review board approval was obtained for this study. METHODS: The computed tomographic findings images in 6 consecutive patients with pathologically proven HAC were reviewed retrospectively. Five patients were men and 1 was a woman (mean age, 56 years; age range, 36-68 years). All patients underwent contrast-enhanced computed tomography (CT) performed on a 4-slice multidetector row CT scanner. The mean time interval between CT and surgery was 5 days. Two radiologists who were unaware of the final histological diagnosis reviewed all computed tomographic images retrospectively. Lesion characteristic (ie, number, location, size, density, enhancement, heterogeneity, margin, distribution, presence of necrosis, lymphadenopathy, and distant metastasis) were evaluated. The correlation between the imaging and the pathological findings was analyzed. RESULTS: Most patients had elevated serum alpha-fetoprotein levels (n = 4). The HAC appeared as large tumors (mean size, 4.2 x 3.4 x 3.9 cm), isodense at unenhanced CT (n = 4), moderately enhanced (n= 5), with necrotic areas (n = 6), regional lymphadenopathy (n = 5), and distant metastases (n = 4). The heterogeneity on computed tomographic images correlated well with the presence of hemorrhage and necrosis. CONCLUSIONS: In an old patient with a large necrotic and moderately vascular tumor, the presence of distant metastases, regional lymphadenopathy, and characteristic increased serum alpha-fetoprotein level may suggest a diagnosis of HAC.     

The spectrum of computed tomographic appearance of metastatic masses from testicular neoplasms

Metastatic masses from testicular neoplasms were evaluated with respect to their computed tomographic characteristics. They were divided in three categories: cystic, semicystic, and solid. The common denominator in the first two categories was the presence of teratomatous components. The nonteratomatous masses were solid.     

Müllerian duct cyst: Ultrasonographic and computed tomographic spectrum

A Müllerian duct cyst (MDC) is the persistent remnant of the Müllerian duct. Reports of symptomatic cases are rare, signs and symptoms include perineal pain, dysuria, infertility, hematuria and genital inflammation. The prevalence of MDC has been previously reported as 4% of newborns and 1% in adult males. Herein we report six cases encountered in the past year. Our detection percentage was 1% and is compatible with the reported values. The imaging evaluation of symptomatic and asymptomatic patients with MDC is discussed as well as the apparent discrepancy between the number of previously reported cases and the reported prevalence.