CT findings in two cases of lobular capillary haemangioma of the nasal cavity: focusing on the enhancement pattern

Lobular capillary haemangioma, known as pyogenic granuloma, is a relatively common benign vascular neoplasm that is composed of hyperplastic clusters of capillaries arranged in a lobular architectural pattern. Most mucosal lobular capillary haemangioma (LCH) of the head and neck arise in the oral cavity, but the nasal cavity involvement is rare. We report here on the CT imaging findings of two cases of LCH involving the nasal cavity, with an emphasis being placed on the different pattern of enhancement of the tumour on the enhanced CT scans.     

MR cholangiography in the diagnosis of sclerosing cholangitis in Langerhans' cell histiocytosis

Langerhans' cell histiocytosis (LCH) is a disorder of histiocytic proliferation that primarily affects infants. Imaging findings of a rare case of lung and liver involvement in an adult are presented. High-resolution computed tomography (HRCT) of the lungs showed confluent thin-walled cystic air spaces compatible with advanced LCH. Liver CT and MRI revealed unspecific signs of fatty infiltration. Irregular widening of peripheral bile ducts was displayed in breath-hold MR cholangiography. This pattern is considered characteristic for sclerosing cholangitis and should support the diagnosis of LCH in case of concomitant cystic pulmonary disease, even in adult patients.     

儿童郎格尔汉斯细胞增生症的CT表现（附13例分析 ）

目的 探讨CT对郎格尔汉斯细胞组织细胞增生症（Langerhans cell histocytosis,LCH)造成多脏器损害诊断的价值及限度。方法 分析13例经临床、实验室、病理检查确诊的LCH的CT表现。局限性LCH4例,广泛性LCH9例。全部病例均行颅脑、胸部、肝、脾CT平扫检查,4例行增强检查。结果 男性多于女性,颅穹隆骨破坏依次为颞骨8例、顶骨3例、枕骨2例、额骨1例。CT发现早期骨破坏敏感性高。肿块变化可反映病变由活跃增殖到静止消退的病理过程。下丘脑－垂体轴侵犯影像表现晚于临床。CT可显著LCH不同阶段的肺损害。结论 LCH各脏器损害的影像学表现缺乏特异性。好发部位的典型CT表现可提示诊断,同时对辅助LCH分型、确定治疗方案、估计预后有一定价值。     

儿童郎格尔汉斯细胞组织细胞增生症的CT表现(附13例分析)

目的　探讨CT对郎格尔汉斯细胞组织细胞增生症(Langerhans cell histiocytosis,LCH)造成多脏器损害诊断的价值及限度。方法　分析13例经临床、实验室、病理检查确诊的LCH的CT表现。局限性LCH 4例,广泛性LCH 9例。全部病例均行颅脑、胸部、肝、脾CT平扫检查,4例行增强检查。结果　男性多于女性,颅穹隆骨破坏依次为颞骨8例、顶骨3例、枕骨2例、额骨1例。CT发现早期骨破坏敏感性高。肿块变化可反映病变由活跃增殖到静止消退的病理过程。下丘脑-垂体轴侵犯影像表现晚于临床。CT可显示LCH不同阶段的肺损害。结论　LCH各脏器损害的影像学表现缺乏特异性。好发部位的典型CT表现可提示诊断,同时对辅助LCH分型、确定治疗方案、估计预后有一定价值。     

Role of <Superscript>18</Superscript>F-FDG PET/CT in patients affected by Langerhans cell histiocytosis

Purpose

Langerhans cell histiocytosis (LCH) is a rare hematological disorder for which the utility of¹⁸F-FDG PET/CT is unclear. Our aim was to explore the metabolic features of LCH and the possible role of¹⁸F-FDG PET/CT in LCH evaluation.

Materials and methods

We found 17 patients with histologically proven LCH who underwent 17¹⁸F-FDG PET/CT scans for staging and 42 scans for restaging/follow-up purposes. PET/CT results were compared with those obtained from other conventional imaging modalities (bone scintigraphy, plain radiogram, computed tomography, magnetic resonance).

Results

¹⁸F-FDG PET/CT was positive in 15/17 patients, and it detected 36/37 lesions; all bone and extraskeletal lesions, except for a cecal lesion, were¹⁸F-FDG-avid. Only 1/4 of the patients with lung LCH had hypermetabolic lesions. The average SUV_max of the FDG-avid lesions was 7.3 ± 6.7, the average lesion-to-liver SUV_max ratio was 3.4 ± 2.5, and the average lesion-to-blood pool SUV_max ratio was 4 ± 3.2. In comparison to other imaging methods,¹⁸F-FDG PET/CT detected additional lesions or was able to evaluate treatment response earlier in 33/74 cases; it was confirmatory in 38/74 and detected fewer lesions in 3/74 (all three with lung LCH).

Conclusions

¹⁸F-FDG PET/CT seems to be useful for evaluating LCH when compared to conventional imaging, except in pulmonary cases. It can be used both for staging and restaging purposes.

     

F-18 FDG PET/CT imaging of solitary liver Langerhans cell histiocytosis: preliminary findings

Langerhans cell histiocytosis (LCH) is a disorder of clonal proliferation of Langerhans-type cells. The imaging findings of LCH are not specific. A 27-year-old woman was admitted to our hospital because of liver enzyme elevation without other hepatic signs. Radiological studies were originally interpreted as possible metastatic disease to the liver. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) images demonstrated a diffuse pattern of nodules in the liver with hypermetabolic activity. LCH was diagnosed histopathologically with an ultrasound-guided liver biopsy. This case illustrates the importance of considering proliferative/benign conditions of the liver when interpreting PET/CT. Failure to do so could result in patient mismanagement.     

Soft tissue Langerhans cell histiocytosis with secondary bone involvement in extremities: evolution of lesions in two patients

Langerhans cell histiocytosis (LCH) is an uncommon disorder of unknown etiology with a wide spectrum of biological behavior. The most common sites of involvement are bone, skin, and lung. While osseous LCH can result in secondary soft tissue involvement, primary soft tissue LCH in extremities with secondary bone involvement is rare, and little is known about its natural course. We report two adult patients with multi-organ system LCH who had primary soft tissue lesions with secondary involvement of adjoining bones in lower extremities, and illustrate the important role played by various imaging modalities in detection and monitoring of treatment response. We also document spontaneous clinical resolution of LCH lesions without therapy, and positive response of these lesions to chemotherapy.     

Pulmonary embolism caused by acrylic cement: a rare complication of percutaneous vertebroplasty

A pulmonary embolus of acrylic cement was present in a 41-year-old woman with Langerhans' cell vertebral histiocytosis (LCH) after percutaneous vertebroplasty. Chest radiograph and CT confirmed pulmonary infarction and the presence of cement in the pulmonary arteries. She was treated with anticoagulants, and responded favorably. This rare complication occurred because perivertebral venous migration was not recognized during vertebroplasty. Adequate preparation of cement and biplane fluoroscopy are recommended for vertebroplasty.     

Imaging of multisystem Langerhans cell histiocytosis in an adult

Langerhans cell histiocytosis (LCH) is a rare disease of uncertain aetiology and is well recognised in children. LCH is characterized by granulomatous infiltration of the lung, bone, skin, lymph nodes, liver, spleen, brain, kidneys, and endocrine system. Manifestations vary depending on whether there is single or multisystem involvement. Clinical symptoms are often non-specific and imaging often plays a vital role in suggesting the diagnosis.We will illustrate and describe the imaging findings of multisystem LCH in an adult patient affecting the lung, liver, thyroid, lymph nodes, suprasellar region, and possibly pancreas. Increased familiarity with the imaging features of multisystem LCH should lead to increased diagnostic confidence and potentially earlier disease diagnosis.     

Radiological and histological findings in spinal intramedullary angiolipoma

We report an intramedullary angiolipoma with spinal cord compression studied by MRI, angiography and CT. Angiolipomas of the spine are rare benign tumours containing vascular and mature adipose elements. They are epidural in more than 90 % of the cases; only three cases of intramedullary angiolipoma are described. The clinical picture is nonspecific, but MRI and CT suggest the diagnosis. Accepted: 16 December 1998     

The usefulness of F-18 fluorodeoxyglucose positron emission tomography/computed tomography in patients with Langerhans cell histiocytosis

Objective

Langerhans cell histiocytosis (LCH) has a wide spectrum of clinical manifestations, ranging from spontaneous resolution to rapid progression or death, with the risk of permanent consequences. F-18 FDG PET/CT has been used for assessment of LCH patients. However, its clinical implication has not been well elucidated, mainly due to very low incidence of LCH. The aim of this study was to evaluate the clinical usefulness of F-18 FDG PET/CT in LCH patients.

Methods

A database of 12 patients (mean age 17.8?±?17.9?years; 7 children, 5 adults) who were diagnosed histopathologically as LCH was retrospectively reviewed. Two patients underwent F-18 FDG PET/CT before and after therapy, 6 patients underwent only before therapy and 4 patients underwent only after therapy.

Results

Nine (75.0?%) and 3 patients (25.0?%) had single-system (single site and multiple sites) and multisystem involvements, respectively. Pretreatment SUV_max of patients with multisystem or multiple site involvement of a single-system was significantly higher than that of patients with single site involvement of a single-system (3.29?±?2.52 vs. 1.63?±?0.52, p?=?0.025). One patient showed multisystem risk organs (lung and bone marrow) involvement. In 2 patients, F-18 FDG PET/CT detected additional active LCH lesions not identified on conventional imaging modalities. In follow-up F-18 FDG PET/CT scans, complete resolution was identified in 2 patients and reactivation in another 2 patients.

Conclusions

Results of this study suggest that F-18 FDG PET/CT is useful for identification of active lesions, stratification of disease stages, monitoring of therapeutic response, and detection of reactivation in LCH patients.     

Malignant lymphoma of the cranial vault in an HIV-positive patient: imaging findings

We describe the CT and MR imaging findings in an HIV-positive patient with malignant non-Hodgkin's lymphoma of the cranial vault, a rare site for lymphoma involvement. Autopsy revealed lymphomatous bone lesions, lymphoma in the epidural space, and a large necrotic lymphoma in the soft tissue of the skull.     

Epidural abscess resulting from traumatic esophageal rupture secondary to a flexion-extension injury

An epidural abscess developed several weeks after a traumatic esophageal rupture secondary to a reported flexion-extension injury in a restrained back seat passenger in a motor vehicle accident. Chest radiograph and an Indium study suggested the possibility of a posterior mediastinal abscess. Chest computed tomography (CT) also noted epidural abscess and osteomyelitis, which were confirmed by magnetic resonance imaging (MRI). Diagnosis was delayed significantly by underinterpretation of both chest and CT findings. Obvious positive findings (lower lobe infiltrate on chest radiograph and posterior mediastinal abscess on CT) were noted, but more subtle and very important findings of superior mediastinal widening and extra pulmonary gas bubbles on the chest radiograph and extradural disease displacing the spinal cord on CT were not described. We can find no previously reported case of esophageal rupture associated with flexion-extension injury of the neck. It is also extremely rare for esophageal rupture to remain asymptomatic for more than several hours.     

40例儿童郎罕细胞组织细胞病骨骼病变的影像学诊断

目的 :探讨儿童郎罕细胞组织细胞病 (LCH)骨骼病变的影像学表现及其诊断价值。材料和方法 :回顾性分析经病理证实的儿童LCH 40例 ,均行X线平片检查 ,其中 8例CT扫描。 14例分别于 1个月～ 2年内随访。结果 :本组中颅骨破坏 32例 ,占 80 %;脊柱破坏 9例 ,占 2 2 .5 %;长骨破坏 13例 ,占 32 .5 %;扁骨及不规则骨破坏 4例 ,占 10 %。嗜酸性肉芽肿以颅骨、长骨和脊柱多发 ,其他类型以颅骨多发。结论 :LCH骨骼病变具有多发性、多样性和多变性的特点 ;X线平片是本症诊断的基本手段 ,CT对隐蔽部位病变及病变细微结构的显示优于平片。     

Epidural hematoma as a complication of sphenoid sinusitis and epidural abscess: a case report and literature review

Imaging is of paramount importance in early diagnosis of epidural abscess and its intracranial complications. Typical CT imaging features of an epidural abscess include a hypodense lentiform extra-axial collection with rim enhancement. We present a case of epidural abscess that was hyperdense on CT scan due to the presence of associated epidural hematoma. The literature is reviewed regarding this unusual complication of epidural abscess.     

Tuberculous spondylitis following BCG vaccination

A case of a rare form of BCG osteomyelitis in the spine is presented. After vaccination, the disease started with a lymphadenitis. Later an abscess extended from the pelvic along the psoas muscles into the retroperitoneum. The soft tissue mass extended paraspinally and epidural involvement was also apparent. The vertebral involvement was detected by CT. The radiological findings are discussed with reference to the literature.     

An unusual case of Erdheim–Chester disease with features of Langerhans cell histiocytosis

Erdheim–Chester disease (ECD) and Langerhans cell histiocytosis (LCH) are both exceedingly rare histiocytic proliferations that can involve the skeletal system. We report on a case of ECD with some features suggestive of LCH. Radiographs demonstrated a large lytic lesion in the left femur, with multiple lesions of sclerosis involving both distal femurs and tibias. Both the lytic lesion and a sclerotic lesion were biopsied and demonstrated distinctive histologic features characteristic of ECD in the tibia and features of LCH in the femur. The clinical/radiologic and pathologic features that distinguish ECD and LCH as distinct entities are reviewed, and the underlying biological connection between them is discussed.     

郎格罕细胞组织细胞增生症的临床影像学分析

目的探讨组织细胞增生症(LCH)的临床影像学特点。方法回顾性分析11例临床证实的LCH,X线检查11例,CT检查1例,MRI检查1例。结果肺部弥漫网点状阴影6例;肝脾肿大6例。骨骼病变中:虫噬样破坏3例,囊样膨胀性改变3例,广泛溶骨性破坏5例;软组织肿块4例;骨膜反应5例。MRI检查1例,骨骼病变呈稍长T1、长T2信号。结论LCH骨骼影像学表现具有特征性:累及长管骨时,多有骨膜反应;累及脊椎骨时,椎间软骨多不受累;所有骨骼病变均可出现软组织肿块。LCH单系统受累患者临床预后较好。     

MR imaging of infiltrative muscle involvement with Langerhans cell histiocytosis

Langerhans cell histiocytosis (LCH) consists of three clinical syndromes of varying severity resulting from basic cellular defect leading to lipid deposition within histiocytes. Radiologically, bone lesions are similar in all three forms of LCH and are due to bone destruction. An eosinophilic granuloma of the bone can involve skeletal muscle by direct extension from the bone. However, skeletal muscle involvement is rare and is not reported on MR imaging previously in the English literature. Our case not only shows biopsy-proven muscle involvement by LCH but also reports the first diffuse nodular pattern of muscle involvement by LCH.     

Septic arthritis of a lumbar facet joint associated with epidural and paravertebral soft tissue abscess

Septic arthritis of the lumbar facet joint is rare, probably underdiagnosed, often associated with complications such as epidural abscess and paraspinal muscles abscess. Diagnosis is based on imaging evaluation. Plain radiographs of the lumbar spine are not helpful because often nomal. Bone scintigraphy is very sensitive but non-specific. CT scan can confirm the diagnosis and guide the needle biopsy. MRI is the preferred imaging modality for diagnosis. MRI shows early bone and joint involvement and it is helpful in detecting epidural and paravertebral soft tissue lesions.