Ankylosing spondylitis complicated by trauma: MR findings correlated with plain radiographs and CT

Four patients with ankylosing spondylitis sustained a traumatic spinal injury. In three cases, pseudoarthrosis developed at the discovertebral junction, while involvement of the neural arch occurred in the fourth. Although the diagnosis of ankylosing spondylitis was readily estabished on plain radiographs, magnetic resonance more effectively identified the complicating injury and in two cases demonstrated the presence of cord compression. Computed tomography was also contributory in delineating bony and ligamentous abnormalities of the neural arch.     

Concha bullosa: Frequency and appearances on CT and correlations with sinus disease in 308 patients with chronic sinusitis

The purposes of this study were to determine the prevalence of concha bullosa in patients with chronic sinusitis, to assess the origin of the pneumatisation (from the anterior or posterior ethmoid cells), and to evaluate the significance of the concha bullosa in the genesis of inflammatory sinus disease. We reviewed the CT studies of 308 patients with chronic sinusitis, assigning four grades of pneumatisation: absent, small, medium and large. Unilateral or bilateral concha bullosa was found in 164 patients (53%). In 79% of cases it was pneumatised via the posterior ethmoidal cells and in 21% via the anterior. A small concha bullosa was associated with abnormalities of the maxillary sinus, ethmoidal cells and ostiomeatal unit respectively in 49%, 28% and 34% of cases, whereas with a large concha bullosa the association was 55%, 36% and 41% respectively on the ipsilateral side and 55%, 32% and 41% on the contralateral side. The usually accepted hypothesis that the concha bullosa may contribute to the pathogenesis of inflammatory sinus disease seems doubtful.     

Amyloidoma of the skull: plain radiographs,CT and MRI

Amyloidomas involving bone are rare. The 67-year-old man reported here had a large amyloidoma of the left frontal, parietal, sphenoid (greater wing) and temporal bones causing neural compression. Plain radiographs CT and MRI are shown.     

Widespread Castleman disease: CT findings

The widespread form of Castleman disease is a rare condition with aggressive, often fatal course, We describe the imaging findings of two patients with extensive Castleman lymphadenopathy. The duration of the disease was 8 years in one patient and 4.5 months in the other.     

Suspected ureteral colic: plain film and sonography vs unenhanced helical CT. A prospective study in 66 patients

The aim of this study was to compare the sensitivity and specificity of plain abdominal films plus ultrasound, vs nonenhanced CT for the diagnosis of ureteral colic in patients with acute flank pain. During a 4-month period, 66 patients (mean age 48 years) with acute flank pain were prospectively studied by means of plain abdominal film, US, and unenhanced CT. The presence of lithiasis and of obstructive uropathy signs were determined. The plain film was only used as a guide for the US exam. Clinical follow-up of all patients was obtained. Ureteral lithiasis was confirmed in 56 patients. The CT had a greater sensitivity (93 vs 79%) and negative predictive value (71 vs 46%) for the detection of lithiasis. The combination of lithiasis plus obstructive signs showed a sensitivity and a specificity of 100% for CT and of 100 and 90%, respectively, for US. The 11 lithiasis not detected by US were passed spontaneously (10 were <5 mm). Both techniques showed similar extraurinary pathology. Computed tomography is the most accurate technique for the detection of ureteral lithiasis; however, the combination of plain film and US is an alternative to nonenhanced CT with a lower sensitivity and radiation dose that has a good practical value.     

Antrochoanal autopolypectomy: CT findings

Antrochoanal polyp (Killian polyp) is an infrequent, benign lesion of maxillary origin.We describe the basic characteristics of this lesion and a rare case of autopolypectomy. Coronal and axial CT images are presented before and after autoexpulsion of an antrochoanal polyp in a patient with long-standing nasal obstruction. The initial CT examination revealed a typical left antrochoanal polyp filling all the maxillary sinus and passing through the ethmoid infundibulum until the choana. The CT after autopolypectomy showed the secondary mass effect at surrounding structures and residual inflammatory changes. Received 11 March 1996; Revision received 3 July 1996; Accepted 2 August 1996     

CT findings in malignant meningiomas

Summary Recurrent meningiomas are due usually to incomplete removal as in the case of basal meningiomas where the tumour surrounding vessels and nervous structures cannot be completely excised. Recurrent meningiomas of the convexity are rare after resection. In most recurrent cases histological changes are noted which may explain the rapid growth, the aggressive nature and also the malignancy of the tumour. These changes include increased mitotic activity, necrosis and invasion of the adjacent brain parenchyma. CT findings in malignant meningiomas are related to the microscopic appearance of these tumours: tumoral necrosis determines heterogeneous enhancement; brain invasion explains the irregular outline of the tumour and sometimes the absence of surrounding low attenuation area. The authors report 5 malignant meningiomas in which the CT findings are correlated with the microscopic findings.Presented in part at the 17th Annual Meeting of the German Society of Neuroradiology, Tübingen, 8–10 October 1981.     

Traumatic trapped penis: ultrasonography and CT findings

We report the case of an 18-year-old man who presented with traumatic trapped penis after a motorcycle accident. Ultrasonography (US) and CT scan disclosed a trapped penis buried within the prepubic fat. Imaging findings of the traumatic trapped penis and the role of imaging study for this rare clinical condition are discussed.     

Adrenal injuries: spectrum of CT findings

Injury to the adrenal gland is often incidentally diagnosed with Computed Tomography (CT) following blunt abdominal trauma. In a high percentage of cases, it is accompanied by other intra-abdominal, retroperitoneal or intrathoracic injuries. Although not usually clinically significant, adrenal traumatic lesions can be a source of infection, as well as a cause of acute adrenal insufficiency. We discuss and illustrate typical and less common CT findings of adrenal injuries. Electronic Publication     

Serious horse-riding accidents: imaging findings and evaluation with multi-slice CT

Purpose: To assess acute phase multi-slice CT findings in horse-riding accidents in patients referred to a level one trauma center. Methods: Using PACS, we retrieved all CT requests during a time period of 19 months. Patients who had a horse-riding accident and were examined with multi-slice CT were included. The imaging findings of multi-slice CT were retrospectively evaluated by location and injury mechanism. Results: Forty-six patients (3 male, 43 female, age 16–55 years, mean age 30) were assessed. The injuries we found were five head, three facial, 13 spine, five body, two pelvic, and three lower extremity trauma. Multiple injuries were seen in five (11%) patients. In 21 patients (46%) the initial multi-slice CT examination(s) was normal. Three main injury mechanisms were established; falling off a horse (72%), a horse kick (11%), and crushing injury caused by a falling horse (13%). Fifteen (33%) patients had serious injuries, one lethal and they were associated more frequently with falling off a horse. Conclusion: Serious injuries with horse riding accidents are not uncommon. In two thirds of patients, the injury mechanism was falling off a horse. Multiple injuries were seen in 11% of cases. In the acute phase, multi-slice CT provided fast and valuable information in assessing these injuries. Electronic Publication     

Persistence of the notochordal canal: plain film and CT findings

We describe two cases of persistent notochordal canal documented by plain films and computed tomography as a vertical central canal surrounded by a rim of osteosclerosis extending the depth of the vertebrae involved.     

Another CT sign of sinonasal polyposis: truncation of the bony middle turbinate

In order to study the features of sinonasal polyposis (SNP) on CT, 100 consecutive coronasal sinus CT examinations done for chronic inflamamtory sinonasal disease were reviewed. The CT findings of the 27 fully documented SNPs were analyzed. All our SNPs were bilateral. There was a strong tendency for extensive involvement. Nasal polyps were seen in 22 of 27 (81%); bony trabecular deossification in 23 of 27 (85%); widening of infundibulum in 26 of 27(96%). We discovered a new sign truncation of the bony middle turbinate, where the bulbous part of bony middle turbinate was missing, in 51 of 26 (58 %) of SNP patients without a previous history of middle turbinectomy, 12 of 15(80%) were bilateral. The one SNP patient (1 of 27) with previous middle turbinectomy was not regarded to be real truncation. Truncation of the bony middle turbinate is a characteristic and easily recognizable ancillary sign, and is not seen in other patterns of sinusitis. Together with other features on coronal sinus CT, this adds diagnostic confidence in diagnosing sinonasal polyposis. Correspondence to: E. Y. Liang     

Paracoccidioidomycosis of the central nervous system: CT findings

A retrospective analisis of six cases of central nervous system paracoccidioidomycosis, all but one proven by biopsy and surgery, was carried out to study the CT and clinical data and pathological correlation. Most of the patients were from the country. Headache, vomiting, seizures and hemiparesis were the most frequent symptoms. Papilloedema was present in four patients with raised intracranial pressure. Five patients had chronic lung disease and two with advanced systemic disease, skin and mucous membrane lesions were also observed. The neurological disturbance was sometimes the presenting features and the diagnosis was discovered incidentally after surgery. Both solitary and multiple parenchymal lesions were observed and the cerebral hemispheres were more commonly involved in four patients. Local meningeal involvement was observed in one with a single cortical granuloma. We enphasise the usefulness of CT, showing a rounded or lobulated mass with an isodense or radiolucent centre after contrast enhancement, surrounded by an irregular wall of varying thickness. There was always moderate oedema, extending peripherally. Other infections or neoplastic diseases may present similar findings. Preoperative diagnosis should rest on integration of clinical data, chest films, laboratory and neuroimaging studies.     

Primary choriocarcinoma of the stomach and pancreas: CT findings

In this report we present the CT findings of two non-gestational,extragonadal choriocarcinomas, one arising within the stomach and one in the pancreas. These are rare tumours and a pancreatic primary site has not been previously described. Received 1 July 1997; Revision received 17 November 1997; Accepted 20 January 1998     

Gas in the kidney: CT findings

Gas in the renal parenchyma is a rare finding seen best with computed tomography (CT). It can be encountered in a wide range of clinical conditions, some of them life-threatening like emphysematous pyelonephritis, whereas in others, it may represent a postoperative or procedure outcome. The latter are not usually a clinical emergency (for example, after nephrostomy insertion or in a urinary intestinal connection). Due to the increasing use of abdominal CT examinations, radiologists, especially in emergency setting, should be aware of this rare finding and be familiar with its differential diagnosis.     

CT and MR findings in HIV-negative neurosyphilis

BACKGROUND AND PURPOSE: The purpose of this study was to describe and evaluate neuroimaging findings of patients with neurosyphilis. METHODS: The neuroimaging studies of 14 patients with documented neurosyphilis were reviewed. Diagnosis was established in 14 patients with cerebrospinal fluid for a Treponema Pallidum Particle Agglutination (TPPA) test. All patients had reactive TPPA and Unheated Serum Regain test (USR) in their sera. Imaging studies included plain, contrast-enhanced CT of the brain, plain and gadolinium-enhanced MR, and MR angiography. RESULTS: In the 14 HIV-negative patients with neurosyphilis, CT and MR showed the presence of cerebral infarction in six cases, arteritis in four cases, nonspecific white matter lesion in three cases, acute syphilitic meningitis in one case and normal neuroimaging finding in one case. In addition, 4 in 14 patients had general paresis, and MRI showed high signal intensity on T2 -weighted images involving frontotemporal lobes, hippocampus and periventricular area. Treatment with penicillin significantly diminished the size of these high signal intensity on T2-weighted images with general paresis. CONCLUSION: These results suggest that MR and CT images have some characteristic manifestations in patients of neurosyphilis. Because early diagnosis and treatment of neurosyphilis are crucial to avoid persistent brain damage, the neuroimaging findings are valuable adjunct to clinical diagnosis and to provide useful information to follow-up after therapy.     

Medulloblastoma in children: CT and MRI findings

Our purpose was to determine whether medulloblastoma (MB) shows specific neuroradiological features which may be employed in differential diagnosis from other common posterior cranial fossa tumours in childhood. Preoperative MRI was performed on 20 children with MB, and preoperative CT in 17 of them. All underwent surgery and histopathological diagnosis. There was a constant relationship between high density on CT and low signal on T1-weighted images. Signal behaviour on T2-weighted images and the degree of contrast enhancement were more variable. Most tumours arose in the midline, from the cerebellar vermis, involving the fourth ventricle, but hemisphere and extra-axial neoplasms were also seen. The combination of high density on CT and low signal on T1-weighted images is highly suggestive of MB and may assist preoperative differential diagnosis from other posterior cranial fossa tumours.     

Tuberculous otitis media: findings on high-resolution CT

We describe two cases of tuberculous otitis media studied with high-resolution computed tomography (CT). Findings included extensive soft tissue densities with fluid levels in the tympanic cavity, the antrum, the mastoid and petrous air cells. Multifocal bony erosions and reactive bone sclerosis were seen as well. CT proved valuable for planning therapy by accurately displaying the involvement of the various structures of the middle and inner ear. However, the specific nature of the disease could only be presumed. Correspondence to: D. Lungenschmid     

Cecal volvulus: CT findings and correlation with pathophysiology

The purpose of this study is to report the computed tomography (CT) features of cecal volvulus and to determine the accuracy of CT in distinguishing the three pathophysiological types of cecal volvulus. The CT studies of ten patients with surgically confirmed cecal volvulus were reviewed. For each patient, CT findings were looked for and recorded. The precise location of the cecum within the abdomen, the presence of an ileocecal twist, and the clockwise or counterclockwise direction of the whirl sign were specifically analyzed. All these results were confronted to the surgical diagnosis retrospectively correlated with the three types of cecal volvulus. According to our classification based on the analysis of the location of the cecum within the abdomen and the presence or the absence of a whirl sign on CT scans, the cecal volvulus was defined as the axial torsion type in four (40%) patients, loop type in four (40%) patients, and cecal bascule type in two (20%). For each patient, the result was in full accordance with the type of cecal volvulus diagnosed at surgery. CT is not only a valuable diagnostic technique in diagnosing cecal volvulus and its complications, but it is also useful in distinguishing the three pathophysiological types of cecal volvulus.     

Vacuum phenomenon in osteoarthritis of the atlanto-odontoid joint: CT findings

Out of 620 consecutive examinations of the atlanto-odontoid joint in patients referred for computed tomography (CT) of the brain or paranasal sinuses, gas collection within the atlanto-odontoid joint was observed in 12 (1.9%). Degenerative abnormalities at the atlanto-odontoid joint were significantly more frequent in patients with a gas-induced vacuum phenomenon than in an age-matched control group. The CT findings and association of the vacuum phenomenon with osteoarthritis of the atlanto-odontoid joint are discussed.