Uncommon CT findings in relapsing polychondritis

Relapsing polychondritis is a rare inflammatory disorder of cartilage with well-established clinical features and imaging characteristics. Abnormal calcification and erosion of cartilaginous structures are the traditional radiographic findings. As with any disease, aberrancies of the expected clinical presentation may lead to a delayed (or missed) diagnosis. We discuss a rare case of relapsing polychondritis in which the diagnosis was suggested on the basis of CT findings, despite uncharacteristic clinical and radiographic manifestations of the disease.     

Carcinoma of the small intestine and colon as a complication of Crohn disease: radiologic manifestations

Barium examinations of the large and small bowel were analyzed in six of seven patients who had adenocarcinoma in areas of the intestine affected with Crohn disease; radiographic changes were correlated with clinical, surgical, and pathologic findings. Radiographic examinations were available in five of these patients at the time of diagnosis of tumor. Two of the five patients demonstrated classic radiographic changes associated with carcinoma. In the other three cases, the radiographic changes were atypical for carcinoma and demonstrated progression of disease over time to include more portions of the bowel and presence of fistulas, strictures, and obstruction. The most frequent clinical presentation of adenocarcinoma in these patients was a recrudescence of symptoms after a long quiescent period. In patients with long-standing Crohn disease plus these clinical features and the above radiographic findings, the diagnosis of a coexisting carcinoma should be considered.     

Central haemangioma: variance in radiographic appearance

Central haemangioma, a "great mimicker" which, fortunately, is a relatively rare condition, may pose a lethal risk for the patient. The diagnosis may become apparent only during biopsy or tooth extraction, which poses a risk of lethal exsanguination; therefore a correct diagnosis is desirable before any biopsy is undertaken. The clinician may not anticipate the severe haemorrhage because of vague clinical history, physical findings and ambiguous radiographic characteristics of the lesion. We report a case of central haemangioma of the mandible whose clinical and radiographic features were equivocal. In addition, an attempt is made to discuss all possible radiographic presentations of central haemangioma and consider differential diagnosis. This case is significant for the reason that it had diverse radiographic appearances in various areas of the lesion in different projections.     

Intra-arterial fibrinolytic therapy for acute mesenteric ischemia

We report a case of mesenteric ischemia secondary to embolic occlusion treated by percutaneous intra-arterial thrombolysis. Early initial radiographic evaluation included abdominal plain film, ultrasonography, abdominal CT, and arteriography. Only selective superior mesenteric artery angiography provided definite diagnosis. The duration of ischemic symptoms before thrombolysis was 6 hours. Post procedure angiogram at 12 hours showed complete resolution of the mesenteric arterial thrombus with clinical improvement. The most important criteria for patient survival is early diagnosis and immediate treatment. Direct infusion of urokinase into the superior mesentric artery may be an alternative to surgery in selected patients and particularly in patients without evidence of frank bowel necrosis.     

CT characteristics of orbital pseudotumors and other orbital inflammatory processes

Orbital pseudotumor is a nonspecific inflammatory process of unknown etiology that may mimic a true orbital neoplasm, specifically lymphoma. It exhibits a highly variable clinical and radiographic presentation. Thirty-nine patients with a presumptive diagnosis of orbital inflammatory disease were examined with CT and evaluated with respect to 13 findings associated with inflammatory disease of the orbit. Pseudotumor was included as part of the differential diagnosis in 25 patients. Twenty-one cases received a final (clinical) diagnosis of pseudotumor. The remainder were comprised of a broad range of orbital inflammatory conditions. Key radiographic features required to entertain or exclude the diagnosis of pseudotumor included establishing the presence of an orbital mass, extraocular muscle enlargement, bony erosion, enhancement, and associated paranasal sinus disease.     

Unusual presentation of extranodal diffuse large B-cell lymphoma in the head and neck: description of a case with emphasis on radiographic features and review of the literature

A very unusual radiographic presentation of non-Hodgkin lymphoma (NHL) involving the maxilla is described. The patient was initially managed with antibiotics prescribed to treat what was thought to represent an odontogenic infection. After unsuccessful antibiotic therapy, the patient was referred to an oral surgery clinic where CBCT was performed. CBCT revealed an atypical generalized sclerosis of the affected bone rather than the usual lytic radiographic pattern associated with NHL. Destruction of the sinus floor with infiltration of the sinus was also present. This rare radio-opaque radiographic presentation is described in detail together with the clinical presentation and histopathological findings. The important radiographic features suggesting malignancy that were present in this atypical case of NHL are discussed. A differential diagnosis highlighting the differences between NHL, osteomyelitis and osteosarcoma is also provided.     

重症甲型H1N1流感肺炎胸部X线表现1例报告及文献复习

目的讨论甲型H1N1流感病毒感染的胸部X线表现与临床治疗经过。方法结合文献复习前瞻性地分析1例经实验室检验确诊的甲型H1N1流感患者X线胸片表现及临床结局。结果起初X线胸片显示双肺透亮度减低,双肺野内可见斑片状或磨玻璃样阴影,两肺门、心影、两膈面以及两肋膈角均模糊,经过针对性抗病毒治疗及支持治疗,肺内病灶迅速吸收,临床症状与体征均得到有效控制和明显改善,住院86 d后痊愈出院。结论甲型H1N1流感病毒感染其胸部X线表现缺乏特征性,临床确诊有赖于流行病学资料和实验室检验,而患者的良好预后取决于抗病毒为主的综合治疗与精心监护。     

Post-traumatic rapidly enlarging mucinous carcinoma of the breast with intratumoural haemorrhage: MRI appearances with pathological correlation

Pure mucinous carcinoma of the breast is a histological type of invasive carcinoma and generally shows a slow growth pattern. Rapid growth and intratumoural haemorrhage are rare and there have been no reports presenting such a clinical course and associated radiographic findings. We report a case with atypical rapidly enlarging mucinous carcinoma of the breast after trauma, in which MRI closely reflected the histopathological background and was thought to be useful for differential diagnosis from other highly malignant breast tumours.     

Small-bowel enema in the diagnosis of adhesive obstructions

The small-bowel enema was evaluated in 60 patients in whom a final diagnosis of adhesive obstruction was made by surgery or on the basis of clinical findings. Distinctive radiographic and clinical features were found with single versus multiple bands. While 72% of 32 single-band obstructions were graded as severe, this grading was given to only 34% of 18 obstructions by multiple bands. Extensive adhesions were demonstrated in 10 patients and presented varied radiographic features. The radiographic diagnosis of adhesive obstruction was found to be correct in 36 (87.8%) of 41 patients in whom a surgical diagnosis could subsequently be made. However, an incorrect radiologic diagnosis of obstruction by metastases was made in five patients. They form the basis for a discussion of the differential diagnosis.     

Osteoid osteoma in the differential diagnosis of persistent joint pain

We report 20 cases (13 male and 7 female), mean age 21 years) of juxta-articular osteoid osteoma. The distribution of affected joints was as follows: hip joint (7 cases), knee joint (2 cases), ankle joint (2 cases); iliosacral joint (2 cases), lumbar spine (2 cases), carpus (2 cases), shoulder (1 case), second metacarpal (MCP; 1 case) and first metatarsal (MTP; 1 case). The duration between the onset of symptoms and diagnosis varied from 8 months to approximately 4 years. In juxta-articular osteoid osteoma, the clinical picture and the radiographic findings are often atypical, and this may lead to misdiagnosis and delayed definitive treatment. In young patients with persistent undiagnosed pain, the possibility of an osteoid osteoma should be considered. When the clinical picture is suggestive but radiological findings are negative, we must proceed to further investigation with bone scintigraphy and computed tomography. These examinations should be repeated 1 year after the onset of symptoms because initially negative findings may become positive at a later date. When the diagnosis of an osteoid osteoma is confirmed, surgical excision leads to complete relief of the symptoms.     

髓内高分化骨肉瘤的诊断和鉴别诊断

目的 探讨髓内高分化骨肉瘤的临床、病理、放射学(X线、CT、MRI)特点及鉴别诊断.方法 通过对1例髓内高分化骨肉瘤的分析,结合该肿瘤有关的文献回顾,归纳总结髓内高分化骨肉瘤的临床、放射和病理学诊断要点.结果 发病年龄30～40岁多见,病损范围较大.肿瘤多位于长骨干骺端,特别是股骨下端和胫骨上端,表现为骨髓腔内破坏和修复同时存在的肿物.肿瘤由纤维及骨组织构成,细胞分化良好,核分裂相少见.50%的患者于初诊时误诊为良性病变.结论 该病早期诊断较困难,了解其病理、免疫组化特点,结合临床将有助于做出正确的诊断.     

Anatomic, clinical, surgical, and radiographic correlation of the zygomatic complex fracture.

Understanding the mechanisms by which clinical signs and symptoms are produced is a prerequisite to the correct appreciation of radiographic features. Radiographs of facial trauma are no different in this respect. This paper describes the specific clinical findings associated with each displaced bony fragment of the zygomatic complex fracture. Limitation of jaw movement and flattening of the cheek are produced by depressed fractures of the temporal process or zygomatic arch; unilateral epistaxis is a result of fractures of the zygomatic process of the maxilla or the floor of the orbit; paresthesia or anesthesia of the cheek results from fractures of the infraorbital process or orbital floor; unequal pupil heights is associated with fracture of the frontal process; and decreased extraocular muscle function with diplopia is caused by fractures of the orbital process, frontal process, or orbital floor. The clinical and radiographic findings are correlated with surgical management.     

Torsed wandering spleen as a cause of recurrent abdominal pain in a child

Wandering spleen is an uncommon cause of acute abdomen in children. Diagnosis of this condition is challenging due to its non-specific symptoms, varying intensity and protracted history of presentation. Radiographs and ultrasound imaging provide rapid and reliable means to diagnose this condition without exposure to excessive radiation. We present a case of a torsed wandering spleen in a child with recurrent abdominal pain. We highlight the role of imaging in identifying salient radiographic and sonographic signs for diagnosis.     

CT and MRI findings in gliomatosis cerebri: a neuroradiologic and neuropathologic review of diffuse infiltrating brain neoplasms

The aim of the study was to develop objective criteria that might be helpful for the diagnosis of gliomatosis cerebri (GC) with the highest possible probability based on both the neuroradiological and histopathological findings. Imaging findings in 14 patients with diffuse infiltrating brain neoplasms were studied by two neuroradiologists. Computed tomography and MRI scans were compared with each other side by side. The extent and kind of disease were graded on a scale of 1–5. Interexamination agreement between the two methods was calculated using a kappa analysis. Neither of the neuroradiologists performed the examinations and both were blinded to the histopathological findings, which were also available for all patients, based on biopsy as well as follow-up CT and MRI studies. A neuroradiological–neuropathological correlation was performed. A score system helped to differentiate the findings in three categories: 1 = suggestive of GC; 2 = GC cannot be excluded; and 3 = others. Both CT and MRI were performed in 14 patients with clinical signs and symptoms of an intracerebral tumor. All examinations had diagnostic quality and showed the involvement of at least two brain lobes. Stereotactic biopsy was carried out in all patients. In 2 patients the neuropathological diagnosis was suggestive of GC, in 1 patient glioblastoma, in 2 patients astrocytoma, and in 5 patients nonspecific astrogliotic proliferation. In the remaining 4 cases anaplastic tumor infiltration was diagnosed. The neuroradiological findings in 5 cases were suggestive of GC; in 6 cases a GC could not excluded; and in 3 patients only a slight probability of GC was found. In 2 cases was the neuropathological and the neuroradiological diagnosis of GC concordant. Magnetic resonance imaging is significantly more sensitive than CT in the diagnosis of GC. However, even with multiple, MRI-guided stereotactic biopsies in correlation with intraoperative analysis of the sample by smear preparations by a neuropathologist the antemortem diagnosis of GC is still difficult. Discussion of neuropathological and neuroradiological findings in each case in combination with a score system may help to resolve discrepancies. Received: 3 March 2000/Revised: 1 August 2000/Accepted: 4 August 2000     

Small intestine ischemia simulating primary colonic disease

Clinical and radiographic findings were reviewed for four patients in whom colonic diverticulitis was suspected clinically but in whom small intestine ischemia was proved surgically. In each patient the initial diagnostic studies--plain abdominal radiography and barium enema examination--revealed generalized small intestine distention and non-specific colonic abnormalities, respectively. The latter findings consisted of an extrinsic impression on the superior or inferior aspect of the sigmoid colon with associated thumbprinting or spiculation. In each patient serosal inflammation of the sigmoid colon produced by an adherent segment of the ischemic small intestine was confirmed at laparotomy. In two patients, delay in surgical intervention resulted in small intestine necrosis. In a patient who has clinical signs and symptoms of colonic ischemia, diverticulitis, or small intestine obstruction but nonspecific findings on barium studies, the diagnosis of small intestine ischemia should be considered and further diagnostic imaging, such as angiography or small intestine follow-through examination, should be performed.     

Hajdu-Cheney syndrome: report of a family and a short literature review

We report three members of an Armenian family with Hajdu-Cheney syndrome. The history suggested that five other members of the family were also probably affected. This disorder is important for the radiologist because distinctive radiographic findings make the diagnosis possible before clinical signs and symptoms are fully developed. Additionally, radiographic examination is essential in all patients suspected of Hajdu-Cheney syndrome for confirmation of the clinical diagnosis. Radiographic examination also detects complications of the syndrome not evident on clinical examination.     

Radiographic manifestations of transfusion-related acute lung injury

ObjectiveThe purpose of this article is to describe the clinical symptoms and illustrate the radiological manifestations of transfusion-related acute lung injury (TRALI) as the condition develops. We mention those findings that aid the discrimination from transfusion-associated cardiac overload. We will also point some of the characteristics that increase the risk of TRALI.ConclusionTRALI generally occurs within 1 to 2 h of the start of a blood transfusion. Though the radiographic features of TRALI are nonspecific, the diagnosis is established using clinical and radiological parameters. The diagnosis warrants a high index of suspicion as well as knowledge of its risk factors. There are no specific treatments; the best chance of survival in TRALI is with early diagnosis and prevention.     

Evaluation of suspected mesenteric ischemia: efficacy of radiologic studies

Mesenteric ischemia is a common problem with protean causes. In patients with suspected mesenteric ischemia, early recognition of ischemic bowel and prompt management are crucial and directly connected to patients' prognosis. Because of its cross-sectional capability offering direct visualization of both enteric and perienteric changes, CT has become an essential diagnostic tool in these clinical settings. Although imaging features in mesenteric ischemia often are relatively nonspecific, understanding of the pathophysiology and clinical features of this disorder in various conditions, and radiologic findings, help the radiologist recognize the ischemic bowel and arrive at a correct diagnosis.     

Imaging of carotid canal sympathetic plexus schwannoma

One case report of a schwannoma involving the sympathetic plexus in the carotid canal has been reported previously. This article presents 2 additional cases of this rare entity with associated clinical and unique radiographic findings. All patients presented with diplopia among other symptoms, and they had enhancing masses that smoothly expanded the carotid canal on cross-sectional imaging. Comparison with the index case and differential diagnosis of more common pathologies in this area are discussed.     

Pigmented villonodular synovitis of the hip: review of radiographic features in 58 patients

Clinical and radiographic findings were retrospectively reviewed in a multicentric survey of 58 patients with histologically proven pigmented villonodular synovitis (PVNS) of the hip. The most common clinical features were mechanical pain (47 cases) and limitation of joint motion (47 cases). On plain films, a classic form with large and multiple lucencies was found in 36 cases, followed by an osteoarthritis-like form (9 cases), an arthritis-like form (8 cases), normal radiographic appearance (3 cases), osteonecrosis of the femoral head (one case) and joint destruction with acetabular protrusion (one case). Bilateral involvement of the hips was probable in two patients. In contrast to the knee, the hip showed a high prevalence of bony lesions and joint space narrowing. Although an uncommon disease, PVNS of the hip has to be considered when arthritis is associated with uncharacteristic clinical or radiographic findings.