Peliosis Hepatis with Hemorrhagic Necrosis and Rupture: a Case Report with Emphasis on the Multi-Detector CT Findings

We report here on an uncommon case of peliosis hepatis with hemorrhagic necrosis that was complicated by massive intrahepatic bleeding and rupture, and treated by emergent right lobectomy. We demonstrate the imaging findings, with emphasis on the triphasic, contrast-enhanced multidetector CT findings, as well as reporting the clinical outcome in a case of peliosis hepatis with fatal hemorrhage.     

Imaging findings in intracranial aspergillosis

RATIONALE AND OBJECTIVES: The authors' purpose was to elucidate the various computed tomographic (CT) and magnetic resonance (MR) imaging findings in intracranial aspergillosis. MATERIALS AND METHODS: Retrospective analysis of cranial imaging findings was performed in eight proved cases of central nervous system aspergillosis. The patients ranged in age from 17 to 75 years. Four patients were immunocompromised, and four were immunocompetent. CT was performed in all eight patients, and MR imaging in five. RESULTS: Six patients (75%) had multiple lesions seen on the imaging studies, with a total of 27 focal brain lesions demonstrated. The lesions were most commonly seen in the cerebral hemispheres (n = 21), with lesser involvement of the basal ganglia (n = 2) and the posterior fossa (n = 4). Seven lesions were hemorrhagic on CT and/or MR images. There was a correlation between lesion size and hemorrhage, with hemorrhage more likely in larger lesions (>15 mm). At pathologic examination, foci of hemorrhage were noted within both infarcts and abscesses. Enhancement was noted in five lesions, four of which were confirmed abscesses. Contrast enhancement of the lesions was vague and week in immunocompromised patients but solid and strong in immunocompetent patients. There were 18 lesions without hemorrhage or enhancement; they were either infarcts or abscesses at pathologic examination. Some of these small nonhemorrhagic nonenhancing brain lesions in the subcortical white matter mimicked lacunar infarcts. CONCLUSION: Typical imaging findings of intracranial aspergillosis include multifocal lesions involving the cerebral hemispheres, with hemorrhage in approximately 25% of lesions. Lesional contrast enhancement tends to be stronger in immunocompetent hosts.     

Basal cell adenoma in the parapharyngeal space: MR findings

We report MR findings of a case of basal cell adenoma arising in the parapharyngeal space. On MR imaging, the mass was a well-circumscribed cystic and solid tumor with a thin fibrous capsule and intratumoral hemorrhage. It was confined to the parapharyngeal space, separating from the deep lobe of the parotid gland. The solid portion of the tumor was slightly hypointense/hyperintense to the muscle on T1-/T2-weighted images and was relatively well enhanced on Gd-enhanced T1-weighted images. The cystic contents of the mass were hyperintense on both T1- and T2-weighted images and were proven to be a hemorrhage.     

Prenatal Sonographic and MR Imaging Findings of Extensive Fetal Lymphangioma: A Case Report

We report the imaging findings in a case of fetal lymphangioma involving the retroperitoneum and right lower extremity, and diagnosed by ultrasonography and magnetic resonance (MR) imaging at 26 weeks of gestation. Prenatal ultrasonograms and T2-weighted single-shot fast spin-echo MR images clearly revealed an extensive, multilocular cystic mass with internal hemorrhage in the retroperitoneum extending to the lower extremity.     

Intraventricular Hemorrhage Caused by Lateral Ventricular Meningioma: A Case Report

Meningiomas causing intracranial hemorrhage are rare, and hemorrhage from a lateral ventricular meningioma seems to be even rarer. We report a case of trigonal meningioma in a 43-year-old woman who presented with intraventricular hemorrhage, and describe the CT, MRI and angiographic findings.     

肾上腺创伤的CT表现

目的 探讨肾上腺损伤(AGT)的CT表现特征.方法 回顾性分析1712例因腹部钝伤行CT检查的患者中AGT患者的CT检查结果.结果 1712例中,共发现AGT 29例(1.7%),右侧损伤23例,左侧3例,双侧3例,共32个病灶.主要CT表现:(1)肾上腺血肿:22例25个病灶,呈孤立立圆形或卵圆形肿块,平扫为高密度或混杂密度,三期动态增强扫描均无强化,肿块周围见推移张开的肾上腺肢体,呈弧形线状明显强化.(2)肾上腺肿胀:4例,表现为受损部肾上腺肢体肿胀,体积增大.(3)肾上腺弥漫性出血:3例,肾上腺被出血包埋,正常肾上腺结构消失.1例伴对比剂外溢,手术证实为肾上腺碎裂伴活动性出血.伴随征象主要包括伤侧肾上腺周围条纹状出血浸润影,膈肌脚增粗等.合并其他胸腹部脏器损伤25例.结论 AGT具有特征性CT表现,采用合理扫描技术并正确认识AGT的CT征象有助于避免漏诊和误诊.     

成人出血型烟雾病的CTA表现

目的:探讨成人出血型烟雾病(Moyamoya病)的CTA表现特征。方法:回顾性分析78例诊断为成人Moyamoya病的临床及CTA资料。结果:178例成人Moyamoya病中出血型的发生率为47.4%(37/78);不同性别发病率和发病年龄之间差异均无统计学意义(P0.05)。2出血原因与CT表现:动脉瘤破裂出血发生率16.2%(6/37),以蛛网膜下腔出血(66.7%)为主;脉络膜前动脉破裂出血发生率48.6%(18/37),其中66.7%表现为脉络膜前动脉扩张并伴有后交通动脉扩张,以脑实质出血破入脑室(50%)和单纯脑室出血(27.8%)为主;异常增生的烟雾状血管破裂发生率35.1%(13/37),以单纯脑实质出血(38.5%)和脑实质出血破入脑室(30.8%)为主。结论:依据CTA的表现,结合出血发生的类型和部位,能够进一步推断Moyamoya病出血的原因,为进一步的干预治疗提供依据。     

Spontaneous intracerebral hematomas from vascular causes

Summary The aim of the present study was to assess the diagnostic accuracy of CT in determining the underlying causes of brain hematomas with a state-of-the art CT. For this purpose, CT and angiographic data of 149 subjects with spontaneous intracerebral hematomas (ICH) were statistically compared in a blind, retrospective study, taking angiography, supported when possible by surgical findings, as providing the correct diagnoses. 5 groups were distinguished on the basis of CT data: 103 patients with isolated deep ICH had normal angiograms; 9 patients with isolated superficial ICH and 8 with deep ICH and intraventricular hemorrhage (IVH) had arteriovenous malformations (AVMs). 4 with this combination showed no angiographic abnormalities, one had an aneurysm. 14 subjects with ICH and subarachnoid hemorrhage (SAH) had a middle cerebral or carotid artery aneurysm; and 10 with ICH, SAH and IVH had also an aneurysm, in 7 on the anterior communicating artery. Sensitivity, specificity, positive and negative predictive values were respectively: for AVMs 100, 96, 77 and 100%; and for aneurysms 96, 100, 100 and 99%. Kendall coefficient was 0.95, indicating close correlation between the two modalities. This study confirms that CT can accurately predict the likelihood, nature and location of vascular ICHs. It indicates whether angiography is necessary or not, and if so, what vascular tree ought to be explored.     

微创经皮肾镜取石术后严重出血的DSA诊断和介入治疗

目的 探讨肾结石微创经皮肾镜取石术(MPCNL)术后出血的肾动脉造影表现及超选择性肾动脉栓塞止血的价值.方法 回顾性分析48例肾结石MPCNL术后出血患者的临床与动脉造影资料,分析其肾动脉造影表现、栓塞治疗效果及并发症等.结果 肾动脉造影结果显示MPCNL后出血的原因:单纯假性动脉瘤25例(52.1%)、假性动脉瘤伴动静脉瘘6例(12.5%)、假性动脉瘤伴对比剂外渗1例(2.1%)、肾动静脉瘘11例(22.9%)、血管破裂对比剂外渗2例(4.2%)和包膜动脉曲张1例(2.1%),未发现异常2例(4.2%).46例接受了栓塞治疗,并达到了栓塞治疗成功的DSA标准和临床标准,其中采用聚乙烯醇颗粒(PVA)栓塞18例、PVA+钢圈栓塞5例、明胶海绵栓塞10例、明胶海绵+钢圈栓塞11例、PVA+明胶海绵+钢圈栓塞2例.栓塞后均出现不同程度的栓塞后综合征;术后血清肌酐较术前轻度升高12例.结论 超选择性肾动脉栓塞能有效止血和保存肾脏功能,是MPCNL术后严重出血的首选治疗方法.     

免疫抑制兔肺部真菌感染早期薄层CT表现与病理对照研究

目的 比较免疫抑制兔肺部感染白念珠菌、曲霉菌、隐球菌的薄层CT表现并与病理对照,以加深对肺部真菌感染早期表现的认识,提高临床诊断准确性.方法 建立免疫抑制兔肺部感染白念珠菌、曲霉菌及隐球菌动物模型后,各实验组及对照组行CT扫描观察CT表现,并与病理作对照研究;免疫抑制剂使用前后兔静脉血中性粒细胞值比较采用配对t检验,CT征象及病灶分布比较采用x2检验及Fisher's 精确检验,CT出现病变的时间比较采用独立样本t检验.结果 白念珠菌实验组17只中14只建模成功,隐球菌实验组19只中16只建模成功,曲霉菌实验组17只中15只建模成功;实验动物免疫抑制剂使用前后中性粒细胞值比较:白念珠菌组分别为(2.91±0.92)、(0.35±0.19)×109/L,差异有统计学意义(t=12.484,P＜0.05);曲霉菌组分别为(2.51 ± 0.82)、(0.76 ±0.71)×109/L,差异有统计学意义(t=5.792,P＜0.05);隐球菌组分别为(2.10±0.65)、(0.48±0.22)×109/L,差异有统计学意义(t=8.199,P＜0.05);3种真菌性肺炎胸部CT出现病变时间(白念珠菌组平均为接种后4.36 d,曲霉菌组5.86 d,隐球菌组3.69 d)比较差异无统计学意义(P值均＞0.05);14只白念珠菌肺炎兔中,磨玻璃影(GGO)10只,实变8只,结节1只,病灶累及双肺7只;15只熏烟色曲霉菌肺炎兔中,GGO 13只,实变4只,结节1只,双肺受累9只;16只新生隐球菌肺炎兔中GGO 10只,实变5只,结节1只,病灶累及双肺6只;病理上GGO主要为肺充血、出血、间质增生及炎细胞浸润,肺实变则提示较严重的充血、出血、间质增生、炎细胞浸润及组织坏死与血管栓塞出现.结论 免疫抑制兔肺部白念珠菌、曲霉菌及隐球菌肺部感染模型有较高的建模成功率,3种真菌病变早期在CT上以GGO、实变和结节表现为主,3种真菌性肺炎的早期表现相仿,没有明显差别;其薄层CT表现基本反映病理变化.     

Peptic erosion of the cystic artery with massive duodenal hemorrhage: Therapeutic embolization

Two patients with massive upper gastrointestinal hemorrhage due to duodenal ulceration underwent visceral angiography. In both cases there was extravasation of contrast from the cystic artery directly into the duodenal lumen. Selective transcatheter embolization of the right hepatic artery was performed in each patient, and in both cases, hemorrhage was controlled. Transcatheter embolization is introduced as an effective therapeutic measure in this unusual entity.     

MR imaging of patellar retinacular ligament injuries

Seventeen patients with patellar retinacular ligament injuries were evaluated with magnetic resonance (MR) imaging. MR findings were correlated with clinical, surgical, and arthroscopic findings. The injuries involved the medial retinacular ligament in 16 of 17 patients and the medial and lateral retinacular ligament in one patient. Nine of 17 patients showed MR evidence of a patellar dislocation. In these patients, a triad of findings that included focal impaction injuries involving the lateral femoral condyle, osteochondral injuries of the medial patellar facet, and injuries of the medial retinacular ligament were seen. Seven of the nine patients with patellar dislocation injuries had frank osteochondral injuries. The injured retinaculum had an indistinct, irregular appearance associated with edema and hemorrhage. The patellar dislocations were clinically unsuspected in the initial evaluation of eight of these nine patients. In eight of 17 patients, the mechanism of injury was a patellar tendon tear (n = 1) or valgus hyperextension (n = 7). In the seven patients with hyperextension injuries, three had associated meniscal and cruciate ligament tears. MR imaging can help define patellar retinacular and associated osteochondral injuries, which may be clinically useful information.     

CT and MR imaging of malignant germ cell tumor of the undescended testis

Preoperative localization of the impalpable undescended testis is necessary to facilitate proper surgical planning. There is an increased incidence of malignant change in the undescended testis; demonstration of malignancy before surgery will significantly alter the treatment. We describe the computed tomographic (CT) and magnetic resonance (MR) findings in 2 patients with malignant change in an intraabdominal testis. The CT scan revealed lesions with areas of low density, 1 of which had focal calcifications; MR revealed lesions of predominantly low or intermediate signal intensity on both long and short TR/TE images, with some areas of very high signal on both sequences. After initial management with chemotherapy, the residual tumor was surgically resected. In neither instance was residual normal testis demonstrated. Both CT and MR are ideal methods of examining malignant transformation of the undescended testis, because of their ability to characterize the internal structure of the organ and, in the case of MR, its capacity for multiplanar imaging. They are almost of equal value except for the ability of CT to identify calcification and of MR to diagnose hemorrhage.     

新生儿缺氧缺血性脑病的临床与CT诊断

目的：研究分析新生儿缺氧缺血性脑病的各种CT征象与临床关系.方法：分析58例缺氧缺血性脑病患儿的CT表现,参照诊断标准,以病变累及程度将脑损伤程度进行CT分度、临床分度.结果：累及2个以下脑叶轻度损伤19例（32.7%）;累及3个以上脑叶中度损伤26例（44.8%）;重度损伤累及全脑叶并伴颅内出血13例（22.4%）;蛛网膜下腔出血41例（70.6%）;脑实质内出血5例（8.6%）.结论：CT能客观的显示脑组织受损的程度,有助于指导临床治疗.     

MSCTA在医源性肾出血中的应用

医源性肾出血是肾脏术后最常见的并发症,严重者可发生失血性休克危及生命。多层螺旋CT血管成像(MSCTA)能够对肾动脉病灶、出血责任血管等进行综合评价,为临床治疗及预后提供影像学依据。在简述肾血管解剖、医源性操作与肾出血的基础上,从肾相关手术前(风险评估和手术方案的制定)、术后(早期出血、延迟性出血和动脉瘤破裂风险的评估)、医源性肾出血的影像表现等方面,综述MSCTA在医源性肾出血中的应用现状及进展。     

Intracranial and Spinal Ependymomas: Review of MR Images in 61 Patients

Objective

To compare the age distribution and characteristic MR imaging findings of ependymoma for each typical location within the neuraxis.

Materials and Methods

During a recent eleven-year period, MR images of 61 patients with histologically proven ependymomas were obtained and retrospectively reviewed in terms of incidence, peak age, location, size, signal intensity, the presence or absence of cyst and hemorrhage, enhancement pattern, and other associated findings.

Results

Among the 61 patients, tumor location was spinal in 35 (57%), infrartentorial in 19 (31%), and supratentorial in seven (12%). In four of these seven, the tumor was located in brain parenchyma, and in most cases developed between the third and fifth decade. Approximately half of the infratentorial tumors occurred during the first decade. The signal intensity of ependymomas was non-specific, regardless of their location. A cystic component was seen in 71% (5/7) of supratentorial, 74% (14/19) of infratentorial, and 14% (5/35) of spinal cord tumors. Forty-nine percent (17/35) of those in the spinal cord were associated with rostral and/or caudal reactive cysts. Intratumoral hemorrhage occurred in 57% (4/7) of supratentorial, 32% (6/19) of infratentorial, and 9% (3/35) of spinal cord tumors. In 17% (6/35) of spinal ependymomas, a curvilinear low T2 signal, suggesting marginal hemorrhage, was seen at the upper and/or lower margins of the tumors. Peritumoral edema occurred in 57% (4/7) of supratentorial, 16% (3/19) of infratentorial and 23% (8/35) of spinal cord tumors. Seventy-two percent (5/7) of supratentorial and 95% (18/19) of infratentorial tumors showed heterogeneous enhancement, while in 50% (17/34) of spinal cord tumors, enhancement was homogeneous.

Conclusion

Even though the MR imaging findings of ependymomas vary and are nonspecific, awareness of these findings, and of tumor distribution according to age, is helpful and increases the likelihood of correct preoperative clinical diagnosis.     

累及肾被膜下的血管平滑肌脂肪瘤CT表现

目的：探讨累及肾被膜下的血管平滑肌脂肪瘤CT特征。方法：回顾性分析29例患者33个累及肾被膜下的血管平滑肌脂肪瘤的CT表现,其中10例有尿路排泄性造影检查,5例行MRI检查,2例行DSA检查。15例经手术病理证实。结果：33个肿块的中心均位于肾实质外,肿块最大径范围2.5～12cm,平均（5.4±2.2）cm。富脂肪肿块30个（90.9%）,21个（70%）肿块内脂肪和软组织混杂分布,16个肿块增强扫描软组织呈持续网格状强化,9个（30%）病灶内软组织为结节状,4个病灶均呈持续强化,另1个结节为慢性血肿,其内见动脉瘤;3个（9.1%）病灶呈乏脂肪性肿块,1个早期强化另2个呈持续强化。5个肿块因自发破裂合并出血。结论：累及肾被膜下血管平滑肌脂肪瘤较大,多富含脂肪,CT易于定位和定性诊断,并判断有无破裂出血。     

Computer tomography as the primary radiologic procedure in acute subarachnoid hemorrhage

CT was performed in 149 patients with acute subarachnoid hemorrhage and clinical findings consistent with an aneurysm rupture, and was found informative in most cases when performed within one week after the hemorrhage. CT disclosed in 29 per cent of cases other causes for the hemorrhage than a ruptured aneurysm (intracerebral hemorrhage, tumor, trauma, infarct) and an extensive angiographic evaluation could be omitted. In those patients where the hemorrhage was caused by an aneurysm rupture, the distribution of extravasated blood in the subarachnoid space and the brain parenchyma usually indicated the aneurysm location--angiography could thus be restricted to the proper vessel. These capabilities of CT are sufficient to economically motivate its routine use as the primary investigation in cases with an acute subarachnoid hemorrhage.     

Delayed 99mTc-labeled erythrocyte scintigraphy in patients with lower gastrointestinal tract hemorrhage: effect of positive findings on clinical management

RATIONALE AND OBJECTIVES: This study was performed to determine whether the results of delayed technetium 99m (99mTc)-labeled erythrocyte scintigraphy for lower gastrointestinal tract hemorrhage resulted in different clinical management and outcome from that in cases in which the results of initial scintigraphy were negative or equivocal. MATERIALS AND METHODS: The authors retrospectively reviewed all 398 99mTc-labeled erythrocyte scintigraphic studies obtained emergently for lower gastrointestinal tract hemorrhage at their institution between January 1, 1994, and December 7, 2001. Of 67 patients who underwent delayed studies, 37 had positive findings (average delay, 18.4 hours; range, 6-25 hours) and 30 had negative findings (average delay, 20.1 hours; range, 8-26 hours). Clinical management and outcome were compared between these two groups with respect to duration of hospitalization, volume of blood transfusion, mortality, and the percentage who were treated conservatively or referred for angiography, endoscopy, and/or surgery. RESULTS: Patients with positive delayed studies were referred more frequently for angiography than those with negative studies (35% vs 0%, P < .01). There were no significant differences between patients with positive findings and patients with negative findings with respect to mortality (8% vs 0%, P < .32), transfusion requirements (5.6 vs 3.2 units, P < .20), hospitalization (9.5 vs 6.1 days, P < .11), the percentage treated conservatively (35% vs 37%, P < .90), or the percentages referred for endoscopy (49% vs 60%, P < .50) or for surgery (24% vs 17%, P < .64). CONCLUSION: Positive findings at delayed scintigraphy resulted in increased referrals for angiography but had no other effect on clinical course or outcome of lower gastrointestinal tract hemorrhage.     

Endovascular Therapy for Management of Oral Hemorrhage in Malignant Head and Neck Tumors

Purpose To evaluate the efficacy and safety of endovascular therapy in oral hemorrhage from malignant head and neck tumors. Methods Ten patients (mean age 56 years) with oral hemorrhage caused by malignant head and neck tumors underwent a total of 13 emergency embolization procedures using gelatin sponge particles, steel and/or platinum coils, or a combination of these embolic materials. Angiographic abnormalities, technical success rate, clinical success rate, recurrence rate, complications, hemostatic period, hospital days, survival days, and patient outcome were all analyzed. Results Angiographic abnormalities were identified during 85% of procedures (11/13). The technical success rate was 100% (13/13 procedures). The primary and secondary clinical success rates were 77% (10/13 procedures) and 67% (2/3 procedures), respectively. The overall clinical success rate was 92%, and the recurrence rate was 22% (2/9 procedures) in patients whom we were able to observe during the 1-month period after embolization. No major complications occurred. Several patients in whom gelatin sponge particles had been used complained of transient local pain after the procedure. The median hemostatic period was 71 days (range 0–518 days). Median hospital and survival days were 59 days (range 3–209 days) and 141 days (range 4–518 days), respectively. Three patients survived and 7 patients died during the observation period. Only 1 of these 7 patients died from hemorrhage. Conclusion In conclusion, our findings suggest that endovascular therapy is an effective, safe, and repeatable treatment for oral hemorrhage caused by malignant head and neck tumors.