A reconsideration of the ischiorectal fossa

Summary The ischiorectal fossae of one fresh and 47 preserved cadaver specimens were disected to elucidate its fascial boundaries, neurovascular relationships, spatial orientation, and possible functions. Based upon measurements of approximately half of the dissected specimens, a three-dimensional model of the ischiorectal fossa was developed to clarify visually its fascial relationships and orientation within the perineum. Seven fetal specimens were also dissected for comparative purposes. A distinct fascial septum, the lamina terminalis, connecting the medial and lateral walls of the fossa to form its anterior boundary, was consistently found as a dense fibrous component attaching inferiorly to the posterior aspect of the urogenital diaphragm. The functional significance of the ischiorectal fossa in supporting the urogenital diaphragm, in anal activities, and in sparing the compression of the neurovascular supply to the perineum is discussed.     

Hemorrhage into the ischiorectal fossa—A complication of anticoagulant therapy: Report of a case

Summary A rare case of spontaneous hemorrhage into the ischiorectal fossa is reported. The high incidence of hemorrhage during this form of therapy is noted. The need for vigorous investigation of these patients because of the occasional presence of unsuspected occult disease is stressed. Read at the meeting of the Pennsylvania Society of Colon and Rectal Surgery, Philadelphia, Pennsylvania, April 1970.     

Hemangioma of the rectum: CT appearance

An 18-year-old man who had severe recurrent rectal bleeding and hematuria was found to have a diffuse cavernous hemangioma of the rectosigmoid. A computed tomographic (CT) study was indicated to evaluate tumor extension and therapeutic possibilities. CT scanning revealed a large mass with phleboliths throughout the true pelvis and nodular indentations in the rectosigmoid wall involving the dome and posterior wall of the bladder. A nonhomogeneous and subtle enhancement of the lesion was noticed after injection of contrast medium.     

Calcified gastric carcinoma: CT findings.

The computed tomographic (CT) findings of 13 cases of calcified gastric carcinoma were analyzed retrospectively. Eleven cases were confirmed as a mucinous adenocarcinoma by surgery (three cases), or endoscopic biopsy (eight cases). Two cases were diagnosed as adenocarcinoma by endoscopic biopsy. In all cases the calcifications were of the punctate or miliary shape and the size varied from 1-3 mm in diameter. The calcifications were located in the thickened gastric wall in all cases, and were seen in metastatic lesions such as lymph nodes and the liver in two cases. In 10 cases, some tumor portions showed lower attenuation number than that of the muscle on CT scans, and corresponded to mucin pool in tumor portions histologically. Twelve cases were in inoperable advanced stage.     

Endorectal ultrasonography: evaluation of locoregional extension of cancers of the rectum

The treatment of rectal carcinoma is mainly determined by its local extension, which is difficult to assess before surgery. Our purpose was to determine the reliability of endorectal echography (ERE) in order to provide preoperative assessment of local extension of rectal tumors. Twenty-five patients with rectal adenocarcinoma were included in this study. Seventeen tumors could be felt by rectal examination. ERE was impossible in one case. Echographic data were compared with anatomic findings in 24 patients. ERE provided an accurate assessment of the parietal involvement in 22 cases. The sensitivity and specificity of ERE in determining the spread of the tumor to the rectum alone were 1 and 0.89, respectively, superior to the results provided by clinical examination alone (sensitivity 0.84-specificity 0.76). When the results of the two investigations were identical, all patients were well classified. For lymph node involvement, the sensitivity and specificity of ERE were 0.71 and 0.76 respectively. These results show that ERE is one of the best investigations currently available for assessing parietal involvement of rectal tumors. ERE might be able to determine the appropriate place of radiation therapy, local excision or anal sphincter preservation.     

Tuberculous fibrosing mediastinitis: CT and MRI findings.

Fibrosing mediastinitis is a rare entity usually caused by granulomatous disease. Most cases develop as a complication of histoplasmosis. Mediastinal involvement caused by tuberculosis most often produces focally enlarged lymph nodes, with diffuse mediastinal involvement a very unusual manifestation of disease. The authors describe a patient with extensive tuberculous fibrosing mediastinitis, in whom fibrotic masses produced compression of airways and vascular structures with resultant parenchymal changes.     

Pseudomyxoma peritonei with progressive calcifications: CT findings.

Development of abdominal calcifications due to pseudomyxoma peritonei is rare. The authors present three cases whereby computed tomographic (CT) studies during or after chemotherapy for pseudomyxoma peritonei demonstrated development and progression of punctate calcifications in the abdomen. The clinical and CT findings of these cases are presented together with a brief review of the pertinent literature.     

Mucormycosis of the central airways: CT findings in three patients.

Computed tomographic (CT) findings are described in three diabetic patients with central airways mucormycosis. The CT findings of the tracheobronchial mucormycosis include enhancing areas of mural thickening (n = 3), luminal narrowing (n = 3), intramural air (n = 3), low-attenuation nonenhancing bronchial wall thickening (n = 2), and bronchonodal fistula formation (n = 1). These CT features in a diabetic patient should raise a high index of suspicion for tracheobronchial mucormycosis, particularly when typical radiographic features of pulmonary tuberculosis are absent.     

Babesiosis: CT and hematologic findings

Babesiosis is a tick-borne illness caused by the protozoan Babesia microti. Most patients are asymptomatic but the infection may produce a spectrum of symptoms in immunocomprimised patients, especially asplenic patients. These range from mild fever, sweats, fatigue, and myalgias to severe multiorgan failure, including acute respiratory distress syndrome and death. Radiographic appearances include bilateral patchy air space and interstitial opacities. We report the radiographic, high-resolution computed tomography (HRCT), and hematologic appearances in a 63-year-old man presenting with acute babesisois. HRCT images revealed smooth septal thickening and intralobular lines superimposed on ground glass opacities in both upper lobes. Follow-up HRCT after 2 weeks of therapy demonstrated resolution of the pulmonary parenchymal abnormalities.     

Traumatic pulmonary pseudocysts: CT findings

Traumatic pulmonary pseudocyst constitutes an uncommon, though well recognized, manifestation of closed chest trauma. It is usually encountered in young patients, whose compliant chest wall permits the transmission of great compressive forces to the lung parenchyma and the laceration of the latter. Traumatic pulmonary pseudocyst is usually detected during the imaging evaluation of multi-injured patients with the use of computed tomography, as it is often not apparent in the initial supine anteroposterior chest radiographs. We present 5 cases of trauma patients, in whom we detected the presence of multiple traumatic pulmonary pseudocysts during the imaging evaluation of blunt chest trauma with the use of computed tomography.     

Diversion colitis. Pathologic findings in a resected sigmoid colon and rectum

We present here the detailed pathologic findings in the resected colon and rectum from a paraplegic patient with severely symptomatic diversion colitis and lack of anorectal function. Previous reports of the pathology of this condition have been confined to biopsy findings. A diffuse nodularity caused by lymphoid hyperplasia and an inflammatory process confined to the colorectal mucosa with erosions, crypt abscesses, mucin granulomas, and aphthoid ulcers were the main features. There was minimal distortion of crypt architecture. The pathologic features of this entity are compared to those of other inflammatory disorders of the colon and rectum.     

Indirect CT venography following CT pulmonary angiography: spectrum of CT findings

SUMMARY: Pulmonary embolism (PE) and deep venous thrombosis (DVT) represent two manifestations of the same syndrome, venous thromboembolism. Contrast-enhanced computed tomography (CT) angiography is a practical, efficient alternative to conventional imaging for PE. Following the pulmonary examination, the inferior vena cava (IVC) and the iliac, femoral, and popliteal veins can be studied with CT without additional intravenous contrast administration. Indirect CT venography (CTV) after CT pulmonary angiography (CTPA) simplifies and shortens venous thromboembolism work-up. Initial studies indicate that CTV is comparable to ultrasound in the evaluation of femoral/popliteal DVT. CTV has the advantage of evaluating the iliac veins and inferior vena cava, vessels poorly seen on sonography and venography. Combining CTV with CTPA increases confidence in withholding treatment when results for both the pulmonary arteries and leg veins are negative and increases the diagnosis of venous thromboembolism by 25% over CTPA alone. This pictorial essay will review the normal venous anatomy, CTV technique, and the findings of acute and chronic DVT. Interpretive pitfalls and alternative diagnoses are also reviewed.     

Retractile mesenteritis with colon and retroperitoneum involvement: CT findings.

We report a case of retractile mesenteritis which involved the rectosigmoid colon and extended into the retroperitoneum with ureteral obstruction. These complications are rare. The radiological features [including computed tomography (CT)] are described.     

Perilobular pulmonary opacities: high-resolution CT findings and pathologic correlation.

This pictorial essay illustrates the high-resolution CT and histologic findings of various disease processes that involve the perilobular interstitium.     

Extramedullary hematopoiesis encasing the pelvicalyceal system: CT findings

A rare case of symmetric renal extramedullary hematopoiesis is hypothesized in a patient with longstanding Vaquez' disease and myelofibrosis. At CT, soft tissue densities were found in the renal hilar area encasing the pelvicalyceal system. Although there is nothing specific about the CT findings, the diagnosis can be suggested in the proper clinical setting. The association with generalized osteosclerosis is another diagnostic clue.     

Methotrexate-induced pulmonary injury: serial CT findings

We describe serial computed tomographic (CT) findings of methotrexate (MTX)-induced pulmonary injury. MATERIALS AND METHODS: The cases of 8 patients (3 men and 5 women; mean age 58.6 years, range 16 to 75 years) of clinically diagnosed MTX-induced pulmonary injury were reviewed. Six patients had rheumatoid arthritis, 1 had lupus erythematosus profundus, and 1 had juvenile rheumatoid arthritis. CT findings on admission and at follow-up were evaluated. RESULTS: The most common CT features were diffuse and patchy bilateral ground-glass opacity with (n = 3) or without reticulation (n = 4) and consolidation (n = 1). These opacities showed no predilection for any particular lung zone in 6 patients but did show dependent predilection in 1 patient and upper lobe predilection in 1. Diffuse centrilobular ill-defined nodules were noted in 1 patient, which disappeared on follow-up. During the average post-treatment follow-up period of 31.0 days (range 3 to 76 days), the opacities quickly improved after treatment in 6 patients; however, in 2 patients with pre-existing interstitial pneumonitis the opacities were refractory. CONCLUSION: CT features of MTX-induced pulmonary injury were variable and included diffuse parenchymal opacification, reticular opacities, and centrilobular nodules. These opacities usually responded quickly to treatment; however, those patients with lung fibrosis at presentation may have worse prognosis.