Pulmonary cryptococcosis in immunocompetent patients: CT findings in 12 patients

OBJECTIVE: The aim of our study was to review the CT findings of pulmonary cryptococcosis in 12 immunocompetent patients. CONCLUSION: The CT manifestations of pulmonary cryptococcosis consist of pulmonary nodules or masses measuring 5-52 mm in diameter and focal areas of consolidation. The nodules and masses have a predominantly peripheral distribution in 80% of the cases. Cavitation of nodules or consolidation is seen in approximately 40% of the cases. The infection can be due to Cryptococcus neoformans var gattii or var neoformans.     

Bronchiolitis obliterans in heart-lung transplantation patients: radiologic findings in 11 patients

Patients who survive the postoperative period after combined heart-lung transplantation are at risk for developing progressive airway damage consisting of central bronchiectasis and bronchiolitis obliterans. The cause of these abnormalities is uncertain, but they are thought to represent a form of chronic rejection. The chest radiographs and medical records of 11 transplantation patients with proved bronchiolitis obliterans were reviewed retrospectively. A pathologic diagnosis was made by open-lung biopsy (five patients), transbronchial biopsy (three patients), and autopsy (two patients). Clinical criteria alone were used for diagnosis in one patient. In all patients, the chest radiographs showed parenchymal abnormalities consisting of linear-nodular, nodular, confluent nodular, or diffuse alveolar opacities. Radiographic evidence of central bronchiectasis was present in nine of the 11 patients. This feature was not present on chest radiographs of five randomly selected asymptomatic transplant patients. We conclude that the parenchymal lung changes in bronchiolitis obliterans in transplant patients are nonspecific and are radiographically indistinguishable from other infectious and noninfectious complications. The presence of central bronchiectasis (nine of the 11 patients) may be a distinctive radiographic finding in this group of patients.     

Pneumonia in neutropenic patients

Radiologists have a special role in the management of neutropenic patients. The appropriate investigational technique, frequently targeted differential diagnosis, and the special needs of these patients, need to be understood. Early detection of a focus is the major goal in febrile neutropenic patients. As pneumonia is the most common focus, chest imaging is a special radiological task. The sensitivity of chest X-ray, especially in supine position, is known to be low; therefore, the very sensitive high-resolution CT (HRCT) became gold standard in neutropenic hosts and will probably be replaced by thin-section multislice CT (MSCT) in the near future. Costs of high-resolution CT are low in comparison to antibiotics. An infiltrate needs to be localised, so that a physician can utilise this information as a guidance for invasive procedures for further microbiological work-up. The radiological characterisation of infiltrates gives a first and rapid hint to differentiate between different sorts of infectious (typical bacterial, atypical bacterial, fungal) and non-infectious aetiologies. Follow-up investigations need careful interpretation according to disease and concomitant treatment. Due to an increased incidence of fungal infiltrates even with appropriate therapy, follow-up of an infiltrate must use further parameters in addition to lesion size. Temporary exclusion of infectious involvement of the lung with high accuracy remains of special interest for clinicians.     

Angioradiology in geriatric patients

The number of geriatric patients has increased in the last decade, as shown in diagnostic angiography and angioplasty. Therefore, the radiologist must be prepared for technical problems. Elderly patients need special premedication, care and also more time for each diagnostic and interventional procedure. In these patients, in several situations DSA can be done more efficiently as an inpatient procedure and not on an outpatient situation. Angioplasty of iliac and femoropopliteal injuries in this population is not only a means of treating claudicatio without high risk, but of also preventing amputation of the leg. Also, even though there are few long-term results, it is of interest that PTA can be done again at the same location. Therefore, early DSA is an important method of reducing the amount of high-risk surgery required. The radiologist must therefore realize that geriatric patients require special management and that excellent interdisciplinary cooperation is needed.     

Coccidioidomycosis in renal dialysis and transplant patients: radiologic findings in 30 patients

Asymptomatic primary coccidioidal infection is common. After the initial infection is contained, the organism can remain dormant in the body for years. Immunosuppression related to renal transplantation or dialysis may reactivate dormant disease. Thus, symptomatic disease may be seen in those with no known history of previous coccidioidomycosis who have visited endemic areas only briefly. To determine if coccidioidomycosis produces characteristic radiographic findings in renal transplant and dialysis patients, we reviewed the records and radiographs of all patients in either of these two categories who are known to have developed active coccidioidal infection in southern Arizona since 1965. Thirty patients (12 undergoing dialysis and 18 transplant recipients) were identified. We conclude that the radiographic manifestations of pulmonary coccidioidomycosis in renal transplant and dialysis patients are highly variable. Interstitial and alveolar patterns of disease are equally likely to occur. Extrathoracic infection without evidence of pulmonary disease occurred in 11 patients (37%), but was radiographically demonstrable only as septic arthritis or perinephric abscess.     

艾滋病合并腹部病变的影像学表现

讨目的探艾滋病（AIDS）合并腹部病变的影像学表现。方法回顾性分析6例AIDS合并腹部病变影像学表现（包括超声、CT和MR扫描）。全部病例均做了超声和胸腹部CT扫描（其中4例做了腹部CT增强扫描），1例做了胸腹部MR增强扫描。结果6例中腹部结核4例，包括腹腔淋巴结结核3例和胰腺结核1例，皆伴有其他部位结核。腹腔淋巴结结核典型CT表现为增大的腹膜后淋巴结中央低密度改变，增强后呈环状强化；胰腺结核的CT表现为胰头低密度灶，增强后病灶周围轻度强化。播散性卡波西肉瘤1例，胸腹部CT及MR扫描表现为沿增粗的支气管血管束和肝内门静脉周围分布的肿瘤病灶。盆腔恶性肿瘤1例，CT显示盆腔内占位病灶，壁不规则增厚，中央大面积低密度液化坏死区。结论AIDS合并腹部病变可表现为机会性感染和相关的恶性肿瘤，影像表现对诊断非常有帮助。组织活检可确定诊断。     

Carpal cysts in hemodialysis patients

A new type of amyloidosis due to beta 2-microglobulin depositions has been recently described in long-term hemodialysis patients. This systemic complication mainly affects the osteoarticular system, with diffuse articular symptoms; among them carpal tunnel syndrome is the most frequent. The syndrome etiopathology is unknown, even though many causal factors have been identified, among which the repeated use of non-biocompatible dialytic membranes. The authors conducted a retrospective study of 138 hemodialysis patients, with mean dialytic age of 79.3 months, to evaluate both incidence and evolution of bone cysts involving the carpal bones. Bone cysts were detected in the hands of 18.8% of the patients at the beginning of dialytic treatment; their incidence was over 50% after 10 years of treatment. Their size and number showed a rapid progression after the 6th year of hemodialysis, and their features were not related to osteodystrophic bone lesions. The carpal tunnel syndrome appeared after several years and its incidence was 7.9%; a direct correlation was demonstrated with the size of carpal bone cysts. The influence of hemodialysis membrane type on the occurrence of hemodialysis-related amyloidosis was strong, but not exclusive.     

Transcatheter thrombolysis in cancer patients

Arterial thrombolysis was successfully accomplished in 15 of 18 (83%) cancer patients by the continuous intraarterial transcatheter administration of streptokinase (70 units/kg/h or 5000 u/h and/or urokinase (400–500 u/kg/h) over 24–96 h. In 16 of these patients, the arterial thrombosis was a complication of transcatheter infusion of chemo-therapeutic agents or embolization therapy. A combination of streptokinase, urokinase and heparin (10,000–25,000 U/day) was utilized without significant side effect and was effective in all 8 patients receiving treatment. Creating a tunnel through the clot, daily monitoring of the catheter with repositioning when necessary, and adjusting the type and dose of thrombolytic agent aided the therapeutic management.     

Tongue cancer in younger patients

Tongue cancer involving the anterior tongue often presents at an early stage. The aetiology is strongly associated with smoking and alcohol abuse similar to other squamous cell carcinomas (SCC) of the head and neck (HN). Surgery and radiotherapy, either alone or together, offer the prospect of cure in the majority of patients. However, there remains a group of younger patients less than 40 years old for whom outcome is often poor. Presented here is the case of a 24-year-old woman who developed SCC of the anterior tongue. Despite treatment, loco-regional relapse occurred resulting in death. The literature identifies a distinct subgroup of younger patients who develop HN SCC, particularly of the oral cavity. The aetiology remains unclear. Recent studies have looked at the prognostic significance of various new non-clinico-pathological markers in HN SCC (including p53 tumour suppressor gene, cyclin D1 protein, Ki 67 antigen and tumour angiogenesis). The majority of these studies, as expected, have involved the typical HN patient (male, aged > 60 years old). However, the relevance of these studies is of likely importance to all patients diagnosed with HN SCC. The recent use of these non-clinical-pathological markers in HN SCC, including reference to such studies in younger patients, is discussed. The English literature during the past 30 years is reviewed with reference to the diagnosis of tongue SCC in younger patients.     

外伤性癔症12例

外伤性癔症是指以外伤为诱因引发的瘛症发作,具有临床表现复杂多样、症征不符、临床检查与影像学检查不符,以及精神暗示治疗、电刺激效果明显等特点。我院自1995～2005年共收治外伤性癔症12例,现报道如下。     

Colonic diverticulitis in young patients

The purpose of this study was to evaluate the radiographic and clinical findings in patients age 40 years or younger with colonic diverticulitis.Radiographs and clinical records of 18 patients over a 7-year period were reviewed. The initial diagnosis was made with computed tomography in 16 patients and with barium enema in 2 patients.There were 15 men and 3 women with a mean age of 33 years (range=25–40 years); all of the women were older than 35 years. Seventeen patients had leftsided diverticulitis. and one patient had right-sided diverticulitis. All patients presented with abdominal pain, and 16 patients had both fever and leukocytosis. Seven patients had abscesses on computed tomography; six of these were less than 2 cm in diameter. There was no case of bowel obstruction or fistula. Five patients underwent laparotomy and bowel resection within 2 months of initial diagnosis. Fourteen of 16 patients who underwent computed tomography had more than average amounts of subcutaneous fat and intra-abdominal fat.Although uncommon, diverticulitis in young patients can occur. Most of our patients were obese men. These patients had similar findings and underwent surgery at a similar rate when compared to older patients.