Pulmonary hamartoma: CT findings

Forty-seven patients with a proved (n = 31) or presumed (n = 16) diagnosis of pulmonary hamartoma were studied prospectively by thin-section computed tomography (CT). CT criteria for hamartoma included a diameter of 2.5 cm or less, a smooth edge, and focal collections of fat or fat alternating with areas of calcification. No case of cancer (n = 283) or metastatic disease (n = 72) fulfilled these criteria. Seventeen hamartomas with no detectable calcium or fat were not diagnosed by means of CT. Two other lesions contained diffuse calcium deposits. In 28 lesions, a CT diagnosis of hamartoma was based on the detection of fat (n = 18) or calcium plus fat (n = 10). Twelve such cases were proved histologically by means of thoracotomy or needle biopsy; the remainder, including eight in asymptomatic patients aged 65 years or older, were managed with conservative follow-up.     

Parasternal sonography of the internal mammary vessels: technique, normal anatomy, and lymphadenopathy

Metastasis to the internal mammary lymph nodes adversely affects the disease-free interval and long-term survival in women with breast carcinoma. Since staging of disease in this lymphatic chain is rarely performed at the time of definitive surgical treatment, noninvasive methods have been advocated. The authors present their preliminary experience with a sonographic technique for evaluating the internal mammary lymph nodes, artery, and vein. Longitudinal and transverse images of the first through fourth parasternal rib interspaces were acquired with a 5.0- or 7.5-MHz linear-array real-time system. The method was evaluated prospectively in 36 control subjects and in seven patients (six with metastatic breast cancer and one with lymphocytic lymphoma) who had enlarged internal mammary lymph nodes at thoracic computed tomography (CT). The longitudinal scans routinely demonstrated the internal mammary vessels in the upper interspaces. Lymphatic structures were not identified in the control group. In contrast, sonographic findings corresponding to the CT findings of lymphadenopathy were present in all seven patients. The authors believe that parasternal sonography is a promising technique that merits further study.     

Prenatal diagnosis of sacrococcygeal teratoma: sonographic-pathologic correlation

The prenatal sonograms of 15 fetuses with sacrococcygeal teratoma were reviewed to determine the sonographic appearance and the role of sonography in the obstetric management. Each tumor appeared as a large mass arising from the fetal rump. The teratomas exhibited three sonographic patterns: nine were mixtures of cystic and solid components in equal proportions, four were predominantly solid with a few scattered anechoic areas, and two were unilocular cystic masses. Calcifications were detected in six cases. There was no correlation between the sonographic appearance and the presence of immature or malignant components. Ultrasonography allowed visualization of an intraabdominal component in six cases and assessment of findings that were of prognostic importance. Prenatal detection and size determination of the external component can play an important role in planning obstetric management because fetuses with a large tumor should be delivered by cesarean section to avoid dystocia and catastrophic hemorrhage during delivery.