Etiologic significance of anatomic variations in the main intrahepatic bile ducts in hepatolithiasis

Abnormal union of intrahepatic bile ducts has been suggested as a possible etiologic factor in the occurrence of intrahepatic stones. A series of 241 patients were examined by direct cholangiography, and anatomic variations in the intrahepatic bile ducts were classified into four types: Type A-1, normal union having a true right hepatic duct; Type A-2, absence of a right hepatic duct, with a trifurcation; Type B, posterior segmental duct draining into left hepatic duct; Type C, anterior segmental duct draining into left hepatic duct. The most dominant type was Type A-1, which occurred in 58.3 to 66.0 per cent of the cases, followed by Type A-2 with 12.5 to 19.8 per cent. Type B showed the lowest incidence, occurring in 4.5 to 10.4 per cent. No statistical difference existed in the distribution of the type of union of intrahepatic bile ducts on the one hand and the presence or absence of intrahepatic stones on the other. Thus, anatomic variations in the main intrahepatic bile ducts do not seem to be associated with hepatolithiasis, and their etiologic significance seems to be unlikely.     

Thin-section computed tomography of the normal minor fissure

The minor fissure was studied with thin computed tomographic (CT) sections (2 mm thickness, 3 mm interval) in 50 patients. It showed high density line or area in all patients. In nine patients CT sections were not obtained through the all region of the minor fissure. Of other 41 patients the fissure was complete in 12 (29%), slightly incomplete in 18 (44%), half incomplete in 7 (17%), and considerably incomplete in 4 (10%). The upper surface of the middle lobe appeared to be upwardly convex in all 50 patients. The location of the highest portion of the minor fissure was hilar in 12 (24%) of 50 patients, medial 1 (2%), anterior 0 (0%), lateral 8 (16%), posterior 3 (6%), dorsal 10 (20%), central 12 (24%), others 2 (4%), and indeterminate 2 (4%). The minor fissure was higher medially than laterally in 22 (44%) patients, and higher posteriorly than anteriorly in 40 (80%) patients. The lowest portion of the minor fissure was anterior in 20 (40%) patients, lateral in 4 (8%), and posterior 3 (6%). The anterior vein of the anterior segment of the right upper lobe (V3b) came in contact with the minor fissure in 20 (40%) patients. In 18 (90%) of these 20 patients minor fissure medial to V3b was incomplete partially. Three dimensional reconstruction image of the minor fissure improved understanding of the anatomy. Familiarity with the anatomic detail of the minor fissure and with variations in the relationships of the upper and middle lobes is useful in localization or extension of a lesion.     

Neofissure after right upper lobectomy: radiographic evaluation

Following lobectomy of the right upper lobe of the lung, a single fissure, the neofissure, separates the right middle and lower lobes. In 25 patients in whom chest radiographs and computed tomographic (CT) scans were obtained after right upper lobectomy, the neofissure was identifiable to some extent on the radiographs in seven (28%) and on CT scans in 24 (96%). Among those patients in whom the neofissure was seen in its entirety, in 12 of 20 (60%) it was oriented predominantly in the coronal plane, paralleling the course of the original major fissure but displaced anteriorly and superiorly. In seven of 20 patients (35%) the superior aspect was coronal, rotated clockwise toward the sagittal plane inferiorly. In one of 20 patients (5%) the neofissure was oriented predominantly in the sagittal plane. The right middle lobe lies anterior and medial to the neofissure; the right lower lobe lies posterior and lateral.     

高原肺水肿的CT诊断

目的：探讨高原肺水肿的CT诊断价值。方法：对16例急性高原适应不全患者进行胸部CT检查，总结其CT表现。结果：其CT表现：（1）早期为磨玻璃样密度增高影，多出现于下叶背段及后基底段，且右下叶早于左下叶；（2）中期为云状密度增高影，若早期未得到及时有效的治疗，则病变密度逐渐增高而形成云絮状密度增高影；（3）晚期可发展到上叶后段及前段，病变充满整个肺叶，可见受累肺段支气管充气；（4）右肺表现重于左肺。结论：CT是高原肺水肿较理想的检查手段。对于高原肺水肿，CT诊断的准确率达100％。     

Arterial blood supply to the posterior aspect of segment IV of the liver from the caudate branch: demonstration at CT after iodized oil injection

PURPOSE: To retrospectively evaluate the arterial blood supply to the posterior aspect of segment IV of the liver with computed tomography (CT) after transcatheter arterial chemoembolization (TACE) with iodized oil through the caudate arterial branch of the liver for treatment of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Institutional review board approval and patient informed consent were not required for this retrospective study. Twenty-four patients (11 men and 13 women; mean age, 68 years) with HCC originating in the caudate lobe (n = 23) or posterior aspect of segment IV (n = 1) were selected. TACE of the caudate arterial branch was performed in all patients, including one patient with HCC in the posterior aspect of segment IV who underwent TACE of the caudate arterial branch after CT helped confirm that iodized oil was not distributed in the tumor after TACE of the medial segmental artery. The distribution of iodized oil in the posterior aspect of segment IV was analyzed with CT 1 week after TACE. The number and origin of all arteries supplying the caudate lobe and the number of arteries embolized were determined. RESULTS: Thirty-three caudate arterial branches were embolized. Twenty-nine branches were derived from the right hepatic artery and four were derived from the left hepatic artery. A single branch was seen in 17 patients, two branches were seen in five, and three branches were seen in two. Eight patients simultaneously underwent additional TACE of branches of the right hepatic artery (n = 6) or right inferior phrenic artery (n = 2). At CT, iodized oil was seen to be distributed entirely (n = 19) or partially (n = 5) in the caudate lobe. Distribution of iodized oil at the posterior aspect of segment IV was observed in 16 patients (67%), including 13 (54%) whose caudate arterial branches were derived entirely from the right hepatic artery. CONCLUSION: The results of this study suggest that the caudate arterial branch, which is mainly derived from the right hepatic artery, frequently supplies the posterior aspect of segment IV. This knowledge is important for managing HCC in the posterior aspect of segment IV by means of TACE.     

Ultrasonography features of the diaphragmatic crura: normal anatomy and its variants

PURPOSE: To report the various US patterns of the diaphragmatic crura and the changes occurring during the different phases of respirations. The diaphragm has two US patterns: the central membranous part appears highly reflective while the posterior, upper and lateral muscular portions are hypoechoic and thick. The crura can sometimes appear quite bulky, which appearance is easy to misinterpret. MATERIAL AND METHODS: We carried out a three-stage work: first we reviewed the US examinations of 23 subjects with a nodular appearance of the posteromedial bundles and studied the changes in thickness during respiration. Second we studied the diaphragmatic crura in 30 subjects aged 18-71 years, 15 men and 15 women. We used a commercially available unit with sector and convex 3.5 MHz probes at baseline and during breath hold and acquired multiple parasagittal and transverse scans. The crura thickness was measured in all patients. Last, we studied the diaphragmatic regions of 10 patients with right pleural effusion and of 8 patients with associated ascites and pleural effusion using 2.0-5.0 MHz convex phased-array transducers. RESULTS: We found focal thickening of the crura in 11 of 23 patients with US findings of diaphragmatic nodules, but only in deep inspiration. The thickening was 1.5-2.2 cm long and maximum thickness was 10 mm. In the other 12 subjects we found 9 small lobules in the right and 3 in the left crus. In the anatomic study, we observed a 3-band appearance of the diaphragmatic crura, probably referable to muscle bundles, in 30 subjects on sagittal images, in 12 on coronal images and in 28 on anterior transverse images. The diaphragmatic crura were identified in 26 subjects only. The left posterior crus was identified in 29 subjects on left coronal images and in 15 on anterior transverse images; it was demonstrated on anterior sagittal images in close proximity to the aorta in only 4 subjects. Right crus thickness, measured on sagittal scans, ranged 3-10 mm in deep inspiration and 1-4 mm in expiration while the left crus was 3-6 mm in inspiration and 1-2 mm in expiration. The length of the right crus, studied in the preaortic portion, ranged from 7 cm in deep inspiration to 9.7 cm in expiration while the left one was 6.5 to 8.8 cm. The right lateral diaphragmatic bundles were seen in 28 subjects only on repeated subcostal oblique scans and the the left ones in 11 subjects only. Finally the thin anterior bundles were shown on parasagittal images in 13 cases in the right side and in 2 in the left. A 2-band appearance of the diaphragm was seen in 10 patients with pleural effusion and in 8 patients with associated ascites. A single band was found only in the tendinous portion of the diaphragm. DISCUSSION AND CONCLUSIONS: US is presently considered the imaging method of choice in the assessment of changes in thickness and length of the diaphragmatic crura. These structures have different US patterns and can sometimes appear quite bulky and thus be easily mistaken for other anatomic or abnormal structures; orthogonal scans may be required for the differential diagnosis.     

Posttraumatic smell loss: relationship of psychophysical tests and volumes of the olfactory bulbs and tracts and the temporal lobes

RATIONALE AND OBJECTIVES: The purpose of this study was to define the primary sites of injury in patients with posttraumatic anosmia and hyposmia with magnetic resonance (MR) imaging and to determine if these sites correlated with the results of psychophysical olfactory tests. MATERIALS AND METHODS: Thirty-six patients with subjective loss in olfaction after head trauma underwent volumetric MR studies of the olfactory bulbs and tracts and temporal lobes. Pearson correlations were computed between olfactory bulb and tract and temporal lobe volumes and the patients' scores on tests of odor identification (including the University of Pennsylvania Smell Identification Test [UPSIT]), detection, and memory. Analysis of variance was used to compare volumes of the control subjects and the posttraumatic patients. RESULTS: The olfactory bulbs and tracts (32 [89%] of 36 patients), the subfrontal lobes (22 [61%] of 36 patients), and the temporal lobes (11 [31%] of 36 patients) showed the highest incidence of posttraumatic encephalomalacia. Left olfactory bulb and tract volumes showed a statistically significant correlation with left and total UPSIT scores. A statistically significant difference (P < .001) was found in the right and left olfactory bulb and tract volumes between anosmic and hyposmic patients and between posttraumatic patients and control subjects. CONCLUSION: Olfactory bulb and tract damage may correlate with deficits in odor identification. Olfactory bulb and tract and frontal lobe encephalomalacia coexist in many patients.     

国人窦房结动脉解剖特点的初步探讨—156例CTA结果分析

目的 探讨256层CT评价国人窦房结动脉形态学特征的应用价值.方法 回顾性分析256层冠状动脉CTA患者156例,对窦房结动脉的起源部位、数目、走行、分支、终止部位进行系统分析观察.结果 98例窦房结动脉单支起源于右冠状动脉近端,37例单支起源于左旋支近端,20例观察到有两条窦房结动脉,分别来自右冠状动脉及左旋支,距右冠状动脉开口45mm、左旋支开口32mm范围内.1例没有观察到窦房结动脉.窦房结动脉发出后至上腔静脉口周围,沿途发出分支供应邻近心房、心耳及房间隔.结论 256层CT冠状动脉成像能够有效显示窦房结动脉,正确评价窦房结动脉的解剖起源、数目、走行及沿途分支.     

Newly diagnosed cystic fibrosis in adults: pattern and distribution of bronchiectasis in 12 cases.

OBJECTIVE: The aim of this study was to analyse the type and distribution of bronchiectasis at computed tomography (CT) in adults with recently diagnosed cystic fibrosis. METHODS: The CT examinations of 12 consecutive patients diagnosed with cystic fibrosis in adulthood (six male, six female; age range at diagnosis 25-63 years) were analysed retrospectively using a modified Bhalla scoring system. Bronchiectasis was catergorized by Reid type and by location within the affected lobe (peripheral, central or mixed). RESULTS: Bronchiectasis was identified in 70 of 71 lobes. Two or more bronchopulmonary segments were involved in 67 of 71 lobes. The majority of lobes demonstrated cylindrical bronchiectasis as the predominant type (n = 51), with varicose (n = 11) and cystic (n = 8) less commonly seen. Bronchiectasis was mainly central in 16 lobes, and both central and peripheral in 54 lobes. The severity of bronchial dilatation was greatest for the upper lobes (mean score, 1.75 right, 1.58 left) compared with the middle lobe/lingula (mean score, 1.42 right, 1.17 left) and lower lobes (mean score, 1.09 right, 1.17 left). CONCLUSION: Bronchiectasis in patients with cystic fibrosis diagnosed in adulthood is usually widespread, predominantly cylindrical, and is more severe in the upper lobes. The diagnosis of cystic fibrosis should be considered in adults with 'idiopathic' bronchiectasis showing these features on CT.     

Peroneal nerve injury in three patients with knee trauma: MR imaging and correlation with anatomic findings in volunteers and anatomic specimens

The aim of this article is to report on three patients with injuries of the peroneal nerve along the posterolateral aspect of the knee. Injuries in this area are less common than the injuries occurring at the level of the fibular head. In this article we report on three patients with posterolateral knee trauma who had peroneal nerve dysfunction. To better understand the precise location of the nerve on MR images, we performed MR imaging in five volunteers, and studied the position of the nerve on anatomic dissection (n=1) and anatomic slices (n=1). The common peroneal nerve is easily depicted on MR images and has a typical location along the posterior margin of the biceps tendon. Non-visualisation of the peroneal nerve at the posterolateral aspect of the knee, as seen on MR images, is consistent with nerve injury. Scar tissue at the posterolateral aspect of the knee indicates injury of this specific area, and involvement of the peroneal nerve is likely.     

Right-to-left shunting via persistent left superior vena cava identified by perfusion lung scintigraphy

A right-to-left shunt was demonstrated following a left antecubital injection of [99mTc]MAA but was not seen after a right antecubital injection. This was because of the presence of a persistent left superior vena cava draining into the left atrium. Recognition of the presence of this anatomic variant is of importance in perfusion imaging, in patients with otherwise unexplained systemic embolization.     

Recurrent thymoma: radiological (CT and FDG-PET) and histological (WHO criteria) features

A 66-year-old man, who had undergone surgical resection of a primary noninvasive thymoma (type B1) in the right anterolateral mediastinum 6 years before, underwent follow-up computed tomography (CT) scanning. The CT scan revealed a few nodules located at the posterior portion of the right thoracic base and just behind the right upper anterior chest wall. Subsequent fluorodeoxyglucose positron emission tomography (FDG-PET) scans showed multiple foci with high [standard uptake value (SUV) 4.3] and low (SUV 2.6) FDG uptake in the right lower posterior area and right upper anterior area of the chest, respectively. The fusion image of the CT and FDG-PET scans demonstrated that the areas of the increased FDG uptake corresponded to those of the nodules on the CT scan. All of the nodules were successfully removed surgically, and the histological features of the nodules indicated that they were type B1 or types B1 plus B2. We regarded the nodule located just behind the right upper anterior chest wall as a type B1 thymoma, whereas those in the posterior area of the right thoracic base as combined thymomas of types B1 plus B2. Our limited experience suggests that the degree of FDG uptake is a reflection of the subtype according to the World Health Organization (WHO) criteria. Furthermore, we showed the role of FDG-PET in the accurate assessment of recurrent thymoma and its therapeutic strategy.     

Sagittal orientation of the anterior minor fissure: radiography and CT

Chest radiographs of 12 patients revealed an oblique, predominantly cephalocaudal linear opacity in the anterior inferomedial aspect of the right lung. Correlation with high-resolution computed tomography in two patients indicated that this opacity represented a sagittal orientation of the anterior minor fissure, with resultant inferomedial curving of the right upper lobe of the lung along the right border of the heart. The sagittal anterior minor fissure may extend inferiorly to the right hemidiaphragm and merge superiorly with the horizontal minor fissure. Autopsy findings in one case showed that this anatomic variant may explain potentially confusing radiographic manifestations of disease in the anterior segment of the right upper lobe of the lung and in the medial segment of the right middle lobe of the lung.     

Minimal asymmetry of the brain: a normal variant

Normal cerebral asymmetry, well-known to neuroradiologists, is not widely recognized by radiologists in general. In our review of CT brain scans, 31 of 300 patients with a negative neurologic examination and no history of birth injury, head trauma, or seizure had recognizable asymmetry of the frontal horns of the lateral ventricles. The right frontal horn and the right cerebral hemispheres were larger than the left twice as often as left were larger than right. The right frontal lobe was wider than the left in 44% of patients and extended as far anteriorly or more anteriorly than the left in 22% of patients. The right central hemispheric mass tended to be wider than the left, resulting in slight displacement of the pineal gland to the left, in approximately 45% of cases. The posterior end of the left Sylvian fissure projected farther posteriorly in 10% of the patients. Occipital petalia and a more posterior position of the calcified glomus of the choroid plexus of the lateral ventricle were both common on the left side of 56%. Earlier studies of the brain by other methods have also shown asymmetry. An awareness of these anatomic asymmetries in normal individuals should preclude the erroneous diagnosis of an atropic or mass lesion.     

Segmental bronchovascular anatomy of the lower lobes: CT analysis

A systematic evaluation of the anatomic relationships of the segmental bronchi, arteries, and veins of 107 right and 113 left lower lobes was made from CT scans of patients with normal chest radiographs. The classic taxonomies of Boyden and Jackson and Huber were used for nomenclature. Identification of individual structures was based primarily on careful analysis of contiguous CT slices. The frequency of identification of each of the major segmental bronchi and their corresponding arteries was established, and variations in the number and position of arteries were recorded at four transverse levels on the right side and three levels on the left side. The segmental venous tributaries of the inferior pulmonary vein were also identified. Although there is considerable constancy in the anatomy of the lower lobe segments, variation from the dominant pattern occurred in as many as 20% of cases. Sometimes major segmental bronchi were not identified and presumably varied in their origin. The segmental arteries may be single, duplicate, or even triplicate. Within the segments, the arteries generally lie toward the lung periphery relative to their corresponding bronchi, thus being anterior, lateral, or posterior. The segmental veins generally lie central to their bronchi, thus being posterior, medial, or anterior. Knowledge of prevailing patterns and variant appearances of the lower-lobe vascular structures can be helpful in interpreting CT scans. Such knowledge is a prerequisite for the identification of pulmonary nodules in the vicinity of vascular structures and the recognition of intersegmental lymph nodes and aberrant vessels.     

Regional grey and white matter volumetric changes in myalgic encephalomyelitis (chronic fatigue syndrome): a voxel-based morphometry 3 T MRI study

Objective

It is not established whether myalgic encephalomyelitis/chronic fatigue syndrome (CFS) is associated with structural brain changes. The aim of this study was to investigate this by conducting the largest voxel-based morphometry study to date in CFS.

Methods

High-resolution structural 3 T cerebral MRI scanning was carried out in 26 patients with CFS and 26 age- and gender-matched healthy volunteers. Voxel-wise generalised linear modelling was applied to the processed MR data using permutation-based non-parametric testing, forming clusters at t>2.3 and testing clusters for significance at p<0.05, corrected for multiple comparisons across space.

Results

Significant voxels (p<0.05, corrected for multiple comparisons) depicting reduced grey matter volume in the CFS group were noted in the occipital lobes (right and left occipital poles; left lateral occipital cortex, superior division; and left supracalcrine cortex), the right angular gyrus and the posterior division of the left parahippocampal gyrus. Significant voxels (p<0.05, corrected for multiple comparisons) depicting reduced white matter volume in the CFS group were also noted in the left occipital lobe.

Conclusion

These data support the hypothesis that significant neuroanatomical changes occur in CFS, and are consistent with the complaint of impaired memory that is common in this illness; they also suggest that subtle abnormalities in visual processing, and discrepancies between intended actions and consequent movements, may occur in CFS.Myalgic encephalomyelitis, or chronic fatigue syndrome (CFS), as defined by the revised diagnostic criteria of the Centers for Disease Control and Prevention, is mainly characterised by persistent or relapsing fatigue lasting for at least 6 consecutive months [1]. As the aetiology of the disorder is currently unknown, it is important to establish whether it is associated with cerebral abnormalities; however, MRI has provided conflicting results when used to search for brain abnormalities in sufferers [2].A recent, large British MRI study by Perrin et al [2] of 18 CFS patients and 9 healthy volunteers, in which the images were examined for abnormalities in brain atrophy, deep white matter hyperintensities, and cerebral blood and cerebrospinal fluid flow, reported no significant differences in brain structure between the 2 groups at either baseline or 1-year follow-up, with the authors concluding that “These results throw open the debate into whether MRI scanning can reveal diagnostic signs of CFS and clinically questions the diagnoses of CFS made on the basis of previous research conclusions.”A small number of previous cerebral MRI studies have been conducted in CFS. A 1993 study involving the comparison by two radiologists of the scans of CFS patients and of controls whom had undergone imaging because of histories of head trauma or headache reported that the former had significantly more abnormal scans than controls (27% vs 2%) [3]; abnormalities included foci of increased white matter T₂ signal in 17% of the CFS patients and ventricular or sulcal enlargement in 10%. On the other hand, a 1997 study of white matter abnormalities found no significant difference between CFS patients and controls [4]. A 1999 study involving the comparison of MR scans by two to three radiologists found, overall, no significant differences between CFS patients and healthy controls, although those CFS patients without a psychiatric diagnosis since illness onset had more brain abnormalities on T₂ weighted images (mostly small, punctate, subcortical white matter hyperintensities, predominantly in the frontal lobes) than patients with such a diagnosis [5].Brain MRI analysis using voxel-based morphometry offers advantages over the methodologies used in the above studies. It is an objective method that is not operator dependent and that does not require a priori information about the location of possible differences between groups. The technique involves spatially normalising all the MR images to the same stereotactic space (by registering each of the images to the same template image, by minimising the residual sum of squared differences between them), segmenting the grey matter from the normalised images, correcting for volume changes arising from spatial normalisation and, finally, carrying out a statistical analysis to localise differences between groups; the output from the method is a statistical parametric map that shows regions where grey matter concentration differs significantly between groups [6,7].Thus far, just one voxel-based morphometry study of CFS has been published. In this 2004 Japanese study of 16 CFS patients, reduced grey matter volume was reported in the bilateral prefrontal cortex [8]. This represents the first report of focal grey matter atrophy in the prefrontal cortex of CFS patients. There have been no attempts, until now, to replicate this finding.Here, we report the largest voxel-based morphometry study of the brain in CFS.     

Intrapulmonary lymph nodes: CT and pathological features.

Intrapulmonary lymph nodes are not uncommon and may be seen frequently in high quality computed tomography (CT) images and chest radiographs. We report four patients, older than 55 years, who had a long history of heavy smoking. Four intrapulmonary lymph nodes were located in the subpleural region (within 3 mm of the visceral pleural surface) of the right or left lower lobes. The lymph nodes were ovoid or round, homogeneous, well-defined and ranged from 9 to 10 mm in diameter. In one case, coexistent small nodules in the same or in other lobes on initial CT studies increased slightly in size over the following 3 years. All nodules contained lymphoid follicles and anthrocotic pigment, and in one case adjacent small aggregates of lymphocytes along interlobular septa were seen. Intrapulmonary lymph nodes have non-specific CT and clinical features. Follow-up CT may be useful in patients with suspected intrapulmonary lymph nodes.     

支气管动脉与食管、主支气管解剖位置关系的320排CT研究

目的：探讨320排CT血管造影(CTA)图像上支气管动脉(BA)与食管和主支气管的解剖位置关系。方法观察142例BA CTA原始图像和后处理图像,记录BA的类型、起源、开口方向及其与食管的伴行关系,并将BA与支气管树图像融合,记录BA与主支气管的位置关系。结果122例患者共检测到BA 273支,其中右侧146支,左侧127支。右侧 BA多走行于食管右后缘,左侧BA多背离食管左侧行走,分别占49.3%和82.7%;左、右侧BA伴多行于食管胸中段,分别占58.3%和42.5%。右侧 BA多在右主支气管后缘与之交叉行走,左侧BA则多走行于左主支气管后上缘,分别占45.2%和60.6%。胸主动脉起源的 BA多开口于9~12点方向,占74.2%。结论320排CTA能个体化、可视化地显示BA在纵隔内与食管的伴行情况及其与主支气管的位置关系,为肺部和纵隔手术提供相关信息与帮助。     

Right top pulmonary vein: evaluation with 64 section multidetector computed tomography

PURPOSE: To evaluate the incidence and anatomic features of the rare variant of the pulmonary veins named "right top pulmonary vein" as depicted with 64 section multidetector computed tomography (MDCT). MATERIALS AND METHODS: MDCT of 610 patients obtained over 12 months period for diagnosis of suspected thoracic or cardiac pathology were routinely reviewed in transverse and 3D images. The frequency of right top pulmonary vein (RTPV) was determined and anatomic features were also documented. RESULTS: Right top pulmonary vein (RTPV) is a supernumerary vein arising from the roof of the right part of the left atrium separately from the orifice of the right superior pulmonary vein. It crosses behind the intermediate bronchus and drains mainly posterior segment of the right upper lobe but also receives few subsegmental branches of superior segment of the right lower lobe. It was detected in 2.2% of patients (14/610). The mean diameter of RTPV was 5.1 mm. CONCLUSION: The RTPV is a rare venous drainage variation of pulmonary veins. It is important to be aware of this anatomic pattern for avoiding misinterpretation of pulmonary venographic findings, inadvertent ablation of pulmonary vein and perioperative bleeding during video assisted thorocoscopic lobectomy.     

CT diagnosis of macrodystrophia lipomatosa. A case report.

Radiographs and CT scans of a 45-year-old male with progressive enlargement of his right upper limb and shoulder are presented. Extensive soft-tissue hypertrophy with linear radiolucent bands (fat) limited to the lateral aspect of the limb were seen. Exostoses-like bony overgrowth were also seen along interphalangeal joints. At CT, hypertrophic adipose tissue intermingling with muscle fibers was demonstrated, a diagnostic finding distinguishing the lesion from plexiform neurofibrolipomatosis, Klippel-Trenaunay syndrome and other angiomatous lesions.